Provider Demographics
NPI:1538421367
Name:DRAGSTEDT, BRIAN (PSYD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DRAGSTEDT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 S DE SOTO AVE
Mailing Address - Street 2:#306
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3146
Mailing Address - Country:US
Mailing Address - Phone:813-344-4325
Mailing Address - Fax:813-864-7335
Practice Address - Street 1:1304 S DE SOTO AVE
Practice Address - Street 2:#306
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3146
Practice Address - Country:US
Practice Address - Phone:813-344-4325
Practice Address - Fax:813-864-7335
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8309103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical