MEDICARE: ABERE S CHURCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY11063	FL

General Provider Information

NPI Number	:	1588236566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABERE S CHURCH

Provider Business Mailing Address
First Line	:	1015 WALTHAM AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-4247
Country	:	US
Telephone Number	:	235-355-8414
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 4TH ST N STE 300
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-5407
Country	:	US
Telephone Number	:	253-355-8414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2021
Last Update Date	:	07/09/2025

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Directions to “ ABERE S CHURCH ” Practice Location

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