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FAMILY PSYCHOLOGICAL SERVICES OF PALM HARBOR, INC.

Company Details

Entity Name: FAMILY PSYCHOLOGICAL SERVICES OF PALM HARBOR, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 26 Jan 1999 (26 years ago)
Document Number: P99000007321
FEI/EIN Number 593556696
Address: 2142 US HIGHWAY ALT 19 N., SUITE C-1, PALM HARBOR, FL, 34683, US
Mail Address: 2142 US HIGHWAY ALT 19 N., C-1, PALM HARBOR, FL, 34683, US
ZIP code: 34683
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1639203763 2007-03-14 2024-01-23 2142 ALT 19 STE C1, PALM HARBOR, FL, 346835361, US 2142 ALT 19 STE C1, PALM HARBOR, FL, 346835361, US

Contacts

Phone +1 727-787-6177
Fax 7277878406

Authorized person

Name DR. ERIC L ROSEN
Role OWNER & PRESIDENT
Phone 7277876177

Taxonomy

Taxonomy Code 103T00000X - Psychologist
License Number PY5165
State FL
Is Primary Yes
Taxonomy Code 103TC0700X - Clinical Psychologist
Is Primary No

Agent

Name Role Address
ROSEN ERIC L Agent 2358 LANDING WAY, PALM HARBOR, FL, 34684

Owne

Name Role Address
Rosen Eric L Owne 2358 Landing Way, Palm Harbor, FL, 34684

Vice President

Name Role Address
Rosen Barbara Vice President 2358 Landing Way, Palm Harbor, FL, 34684

Chief Executive Officer

Name Role Address
Rosen Robert Chief Executive Officer 9721 Montague Street, Westchase, FL, 33626

Clin

Name Role Address
Rosen Karon Clin 9721 Montague Street, Westchase, FL, 33626

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2025-01-27 2142 US HIGHWAY ALT 19 N., SUITE C-1, PALM HARBOR, FL 34683 No data
CHANGE OF PRINCIPAL ADDRESS 2013-01-22 2142 US HIGHWAY ALT 19 N., SUITE C-1, PALM HARBOR, FL 34683 No data
CHANGE OF MAILING ADDRESS 2013-01-22 2142 US HIGHWAY ALT 19 N., SUITE C-1, PALM HARBOR, FL 34683 No data

Documents

Name Date
ANNUAL REPORT 2025-01-27
ANNUAL REPORT 2024-01-25
ANNUAL REPORT 2023-03-10
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-03-15
ANNUAL REPORT 2020-01-17
ANNUAL REPORT 2019-01-28
ANNUAL REPORT 2018-02-02
ANNUAL REPORT 2017-01-11
ANNUAL REPORT 2016-01-26

Date of last update: 01 Feb 2025

Sources: Florida Department of State