Organization
MARY ALSTON KERLLENEVICH, LLC
Active
Other names
Mary Alston Kerllenevich, Ph.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MARY A KERLLENEVICH PH.D. (MGRM)
(904) 824-7733
Entity
Organization
Contact information
Practice address
1100 S PONCE DE LEON BLVD STE 1, ST AUGUSTINE, FL 32084-6013
(904) 824-7733
(904) 829-9768
Mailing address
4900 US HIGHWAY 1 N, SUITE 400, ST AUGUSTINE, FL 32095-6271
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY 7744
FL
Other
Enumeration date
11/19/2008
Last updated
11/19/2008
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