Healthcare Provider Details

I. General information

NPI: 1407486640
Provider Name (Legal Business Name): JAMAR WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 PINELLAS POINT DR S APT 538
ST PETERSBURG FL
33705-6771
US

IV. Provider business mailing address

3840 5TH AVE N
ST PETERSBURG FL
33713-7521
US

V. Phone/Fax

Practice location:
  • Phone: 302-535-3796
  • Fax:
Mailing address:
  • Phone: 727-367-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: