| Luminara Vindi Llc | |
|
300 2nd Ave South East #83 Saint Petersburg FL 33701-3370 | |
| (727) 906-6185 | |
| Not Available |
| Full Name | Luminara Vindi Llc |
|---|---|
| Speciality | Psychologist |
| Location | 300 2nd Ave South East #83, Saint Petersburg, Florida |
| Authorized Official Name and Position | Thomas G Quinlan (CLINICAL PSYCHOLOGY) |
| Authorized Official Contact | 7279066185 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Luminara Vindi Llc 300 2nd Ave South East #83 Saint Petersburg FL 33701-2023 Ph: (727) 906-6185 | Luminara Vindi Llc 300 2nd Ave South East #83 Saint Petersburg FL 33701-3370 Ph: (727) 906-6185 |
| NPI Number | 1619417250 |
|---|---|
| Provider Enumeration Date | 03/01/2017 |
| Last Update Date | 11/17/2023 |
| Certification Date | 11/16/2023 |
| Medicare PECOS PAC ID | 1254617970 |
|---|---|
| Medicare Enrollment ID | O20170412002022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619417250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0700X | Psychologist - Adult Development & Aging | (* (Not Available)) | Primary |
| Provider Name | Thomas G Quinlan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356539837 PECOS PAC ID: 6709973787 Enrollment ID: I20071108000054 |
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