| Mary Alston Kerllenevich, Ph.d. | |
|
1100 S Ponce De Leon Blvd Ste 1 St Augustine FL 32084-6013 | |
| (904) 824-7733 | |
| (904) 829-9768 |
| Full Name | Mary Alston Kerllenevich, Ph.d. |
|---|---|
| Speciality | Psychologist |
| Location | 1100 S Ponce De Leon Blvd Ste 1, St Augustine, Florida |
| Authorized Official Name and Position | Mary A Kerllenevich (MGRM) |
| Authorized Official Contact | 9048247733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Alston Kerllenevich, Ph.d. 4900 Us Highway 1 N Suite 400 St Augustine FL 32095-6271 Ph: () - | Mary Alston Kerllenevich, Ph.d. 1100 S Ponce De Leon Blvd Ste 1 St Augustine FL 32084-6013 Ph: (904) 824-7733 |
| NPI Number | 1033364971 |
|---|---|
| Provider Enumeration Date | 11/19/2008 |
| Last Update Date | 11/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033364971 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY 7744 (Florida) | Primary |
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