Provider Demographics
NPI:1538746227
Name:TRAUMA RECOVERY GROUP
Entity type:Organization
Organization Name:TRAUMA RECOVERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSY.D
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-379-2804
Mailing Address - Street 1:9887 4TH ST N STE 319
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-8445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9887 4TH ST N STE 319
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-8445
Practice Address - Country:US
Practice Address - Phone:727-379-2804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-27
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty