Provider Demographics
NPI:1316247208
Name:NATHANSON, DAVID E (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:NATHANSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1375
Mailing Address - Country:US
Mailing Address - Phone:813-971-6026
Mailing Address - Fax:813-971-6026
Practice Address - Street 1:5012 WESLEY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1375
Practice Address - Country:US
Practice Address - Phone:813-971-6026
Practice Address - Fax:813-971-6026
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3839103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities