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General NPI Number Information
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NPI Number | 1528183738
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Entity Type | Individual
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Provider Name | CHARLES MICHAEL GERARDI
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 620 EDGEWATER DR UNIT 201
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City | DUNEDIN
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State | FL
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Zip | 34698-6980
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Country | US
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Telephone | 727-483-4313
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Fax | 727-953-9281
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Provider Business Mailing Address
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Address Line | 620 EDGEWATER DR UNIT 201
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City | DUNEDIN
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State | FL
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Zip | 34698-6980
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Country | US
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Telephone | 727-483-4313
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Fax | 727-953-9281
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY5833
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License Number State | FL
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