Provider Demographics
NPI:1336020288
Name:TASH, JUSTIN L (MSW)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:L
Last Name:TASH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 CITRUS LEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8535
Mailing Address - Country:US
Mailing Address - Phone:979-422-7803
Mailing Address - Fax:
Practice Address - Street 1:5199 CITRUS LEAF BLVD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8535
Practice Address - Country:US
Practice Address - Phone:979-422-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty