Healthcare Provider Details

I. General information

NPI: 1306947809
Provider Name (Legal Business Name): KARA MATILE HENDRY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5348 1ST AVE N SUITE D
ST PETERSBURG FL
33710-8106
US

IV. Provider business mailing address

P.O. BOX 47918
ST PETERSBURG FL
33743
US

V. Phone/Fax

Practice location:
  • Phone: 727-322-6123
  • Fax: 727-322-6143
Mailing address:
  • Phone: 727-322-6123
  • Fax: 727-322-6143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: