Provider Demographics
NPI:1114029055
Name:WINGERT, FRANK MYRON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:MYRON
Last Name:WINGERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 HABERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-3725
Mailing Address - Country:US
Mailing Address - Phone:727-535-7761
Mailing Address - Fax:
Practice Address - Street 1:433 4TH ST N
Practice Address - Street 2:ST PETE BEHAVIORAL HEALTH CENTER
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-895-8499
Practice Address - Fax:727-895-8497
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1153104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
K4526OtherGROUP PROVIDER PART B
Z6011DMedicare UPIN