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General NPI Number Information
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NPI Number | 1114117157
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Entity Type | Individual
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Provider Name | ANN MARIE USITALO PH.D
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Gender | Female
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 655 W 8TH ST UFJAX - PEDIATRICS RAINBOW CENTER
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-2120
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Fax | 904-244-5341
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Provider Business Mailing Address
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Address Line | PO BOX 44008 UFJP - PROVIDER ENROLLMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone | 904-244-3199
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Fax | 904-244-3425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7309
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License Number State | FL
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