Provider Demographics
NPI:1144621905
Name:JACINTO, GEORGE A
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:JACINTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 GULF BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33786-3500
Mailing Address - Country:US
Mailing Address - Phone:407-453-2594
Mailing Address - Fax:
Practice Address - Street 1:2605 GULF BLVD
Practice Address - Street 2:
Practice Address - City:BELLEAIR BEACH
Practice Address - State:FL
Practice Address - Zip Code:33786-3500
Practice Address - Country:US
Practice Address - Phone:407-453-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 32411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical