Provider Demographics
NPI:1609687219
Name:PREMUDA CONTI, PAOLA (PHD, CRC, CVE)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:
Last Name:PREMUDA CONTI
Suffix:
Gender:F
Credentials:PHD, CRC, CVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 STONES THROW CIR N APT 9301
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4768
Mailing Address - Country:US
Mailing Address - Phone:334-350-1593
Mailing Address - Fax:
Practice Address - Street 1:4700 N HABANA AVE STE 401
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7119
Practice Address - Country:US
Practice Address - Phone:888-666-3089
Practice Address - Fax:888-666-9870
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CRC112478225C00000X
FLIMH26602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor