Provider Demographics
NPI:1548727126
Name:CAROLE SHARMAN
Entity type:Organization
Organization Name:CAROLE SHARMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-341-0097
Mailing Address - Street 1:3103 S DEBAZAN AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4031
Mailing Address - Country:US
Mailing Address - Phone:727-341-0097
Mailing Address - Fax:727-343-6419
Practice Address - Street 1:1135 PASADENA AVE S STE 302
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-2856
Practice Address - Country:US
Practice Address - Phone:727-341-0097
Practice Address - Fax:727-343-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL218196Medicaid