Basic Information
| Provider Information | |||||||||
| NPI: | 1003285503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALONSO | ||||||||
| FirstName: | ANA | ||||||||
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| Credential: | S.S.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2118 W IVY ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336071622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132639636 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2909 W BAY TO BAY BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336298100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133815200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2015 | ||||||||
| LastUpdateDate: | 09/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TS0200X | SS1097 | FL | Y | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.