Provider Demographics
NPI:1366116147
Name:CLAUDE, BERONICA
Entity type:Individual
Prefix:
First Name:BERONICA
Middle Name:
Last Name:CLAUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4339 DEERMONT CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5402
Mailing Address - Country:US
Mailing Address - Phone:813-298-5869
Mailing Address - Fax:
Practice Address - Street 1:4339 DEERMONT CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5402
Practice Address - Country:US
Practice Address - Phone:813-298-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health