Individual
MRS. DINA ANN FORMENTINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10000 BAY PINES BLVD, BAY PINES, FL 33744-8200
(727) 398-6661
Mailing address
2834 3RD AVE S, ST PETERSBURG, FL 33712-1006
(727) 776-5642
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW12387
FL
171M00000X
Case Manager/Care Coordinator
4240785
FL
Other
Enumeration date
09/07/2012
Last updated
05/27/2019
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