Healthcare Provider Details

I. General information

NPI: 1528129269
Provider Name (Legal Business Name): CHRISTINE RECICAR ELLIOTT MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 17TH ST
SARASOTA FL
34235-1843
US

IV. Provider business mailing address

2255 SHADOW LAKES DR
SARASOTA FL
34240-9323
US

V. Phone/Fax

Practice location:
  • Phone: 941-371-8820
  • Fax: 941-363-0680
Mailing address:
  • Phone: 941-371-8820
  • Fax: 941-363-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: