Provider Demographics
NPI:1437388915
Name:BEN C. GHOZALI, PSY.D., P.A.
Entity type:Organization
Organization Name:BEN C. GHOZALI, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOZALI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-215-8348
Mailing Address - Street 1:2843 ALT 19
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1926
Mailing Address - Country:US
Mailing Address - Phone:727-772-0038
Mailing Address - Fax:727-787-2384
Practice Address - Street 1:2843 ALT 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1926
Practice Address - Country:US
Practice Address - Phone:727-772-0038
Practice Address - Fax:727-787-2384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73121OtherBLUE CROSS/BLUE SHIELD