Individual
DR. MARY ALSTON KERLLENEVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
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
1100 S PONCE DE LEON BLVD STE 1, ST AUGUSTINE, FL 32084-6013
(904) 824-7733
(904) 829-9768
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY7744
FL
103TC0700X
Clinical Psychologist
PY7744
FL
Other
Enumeration date
11/07/2006
Last updated
08/12/2008
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