Individual
ANN MARIE USITALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
655 W 8TH ST, UFJAX - PEDIATRICS RAINBOW CENTER, JACKSONVILLE, FL 32209-6511
(904) 244-2120
(904) 244-5341
Mailing address
PO BOX 44008, UFJP - PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3199
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY7309
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005470500
—
FL
05
—
673759339A
—
GA
Enumeration date
07/26/2007
Last updated
05/07/2013
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