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General NPI Number Information
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NPI Number | 1750573135
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Entity Type | Organization
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Legal Business Name | ICM ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 900 CARILLON PKWY SUITE 301
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City | SAINT PETERSBURG
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State | FL
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Zip | 33716-1115
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Country | US
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Telephone | 727-392-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 15454 1ST ST E
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City | MADEIRA BEACH
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State | FL
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Zip | 33708-1803
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Country | US
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Telephone | 727-392-5600
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Fax | 727-499-7517
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Authorized Official
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Title or Position | CEO
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Name | MS. KATHRYN DIANNE CARAVELLA
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Credential | CAC, NCAC1, BRI-1
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Telephone | 727-392-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4013A
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License Number State | FL
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