Doctor Name: | DR. RICHARD A. IPPOLITO |
NPI Number: | 1154516292 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.M.H.C. |
License Number: | MH 3053 |
Business Practice Address: | 638 E Tarpon Ave Tarpon Springs, FL - 346894202 |
Business Phone Number: | 7274551664 |
Business Fax Number: | 7279380775 |
Mailing Address: | 638 E Tarpon Ave, TARPON SPRINGS |
State: | FL |
Postal Code: | 346894202 |
Phone Number: | 7274551664 |
Fax Number: | 7279380775 |
NPI Enumeration Date: | 09/12/2007 |
NPI Last Update Date: | 09/12/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 3053 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |