MEDICARE: DR. JERI QUIRK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	8222	FL
2	101YM0800X	Mental Health Counselor	4808	MA

General Provider Information

NPI Number	:	1922195957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERI QUIRK PH.D.

Provider Business Mailing Address
First Line	:	5200 SEMINOLE BLVD
Second Line	:	SUITE K
City	:	ST PETERSBURG
State	:	FL
Zip	:	33708-3378
Country	:	US
Telephone Number	:	727-395-0544
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 SEMINOLE BLVD
Second Line	:	SUITE K
City	:	ST PETERSBURG
State	:	FL
Zip	:	33708-3378
Country	:	US
Telephone Number	:	727-395-0544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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