Provider Demographics
NPI:1992104111
Name:CHILD AND FAMILY LEARNING
Entity type:Organization
Organization Name:CHILD AND FAMILY LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ABBY
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-399-1625
Mailing Address - Street 1:312 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-2300
Mailing Address - Country:US
Mailing Address - Phone:813-399-1625
Mailing Address - Fax:
Practice Address - Street 1:312 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-2300
Practice Address - Country:US
Practice Address - Phone:813-399-1625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4230103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty