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General NPI Number Information
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NPI Number | 1265944557
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Entity Type | Individual
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Provider Name | SARA JUSTINE MAISON LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 1135 PASADENA AVE S STE 327B
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-6425
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Country | US
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Telephone | 727-465-3462
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Fax |
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Provider Business Mailing Address
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Address Line | 6266 FAIRFIELD AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33707-2323
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Country | US
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Telephone | 727-465-3462
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3401
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License Number State | FL
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