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4835 27th St W Suite 125 Bradenton FL 34207-1768 | |
| (941) 753-0064 | |
| (941) 753-2977 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 4835 27th St W, Bradenton, Florida |
| Authorized Official Name and Position | Debra K Carter (CEO) |
| Authorized Official Contact | 9417530064 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4835 27th St W Suite 125 Bradenton FL 34207-1768 Ph: (941) 753-0064 | 4835 27th St W Suite 125 Bradenton FL 34207-1768 Ph: (941) 753-0064 |
| NPI Number | 1356406235 |
|---|---|
| Provider Enumeration Date | 12/22/2006 |
| Last Update Date | 04/11/2022 |
| Certification Date | 04/11/2022 |
| Medicare PECOS PAC ID | 0547234379 |
|---|---|
| Medicare Enrollment ID | O20040825001457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356406235 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (Florida) | Primary |
| Provider Name | Michael B Spellman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891850772 PECOS PAC ID: 8921095084 Enrollment ID: I20041202000934 |
| Provider Name | Debra Kaye Carter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073672333 PECOS PAC ID: 0446224273 Enrollment ID: I20101115001173 |
| Provider Name | Karim Yamout |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487802781 PECOS PAC ID: 8628247970 Enrollment ID: I20110803000455 |
| Provider Name | Christine Profito |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346590486 PECOS PAC ID: 8729222500 Enrollment ID: I20130917000551 |
| Provider Name | Michael G Railey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124216346 PECOS PAC ID: 3072741586 Enrollment ID: I20140108000551 |
| Provider Name | Patricia A Bach |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225195084 PECOS PAC ID: 4486951621 Enrollment ID: I20160401001447 |
| Provider Name | Brendan J Mccollum |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982046215 PECOS PAC ID: 2264718311 Enrollment ID: I20170404002183 |
| Provider Name | Veronica P Medina |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053804708 PECOS PAC ID: 4385981190 Enrollment ID: I20190131001569 |
| Provider Name | Diane C Addison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578890349 PECOS PAC ID: 2062604747 Enrollment ID: I20200626001852 |
| Provider Name | Thomas Joseph Longo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750552758 PECOS PAC ID: 8820475403 Enrollment ID: I20220520000434 |
| Provider Name | Jared Lee Warren |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093204117 PECOS PAC ID: 0143681262 Enrollment ID: I20230804001149 |
| Provider Name | Kristen Sidwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922838846 PECOS PAC ID: 6204375249 Enrollment ID: I20240822001339 |
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