| Juvenile Out Patient | |
|
6720 54th Ave N St Petersburg FL 33709-1402 | |
| (727) 547-4508 | |
| (727) 524-4345 |
| Full Name | Juvenile Out Patient |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6720 54th Ave N, St Petersburg, Florida |
| Authorized Official Name and Position | Nancy Hamilton (CEO) |
| Authorized Official Contact | 7275457564 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Juvenile Out Patient 6720 54th Ave N St Petersburg FL 33709-1402 Ph: (727) 547-4508 | Juvenile Out Patient 6720 54th Ave N St Petersburg FL 33709-1402 Ph: (727) 547-4508 |
| NPI Number | 1023176401 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 07/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023176401 | NPI | - | NPPES |
| 060705302 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Florida) | Primary |
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