Provider Demographics
NPI:1164638607
Name:HANNIGAN, GINGER (MA LMHC PA)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:HANNIGAN
Suffix:
Gender:F
Credentials:MA LMHC PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 108TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:TREASURE IS
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4747
Mailing Address - Country:US
Mailing Address - Phone:727-424-6199
Mailing Address - Fax:
Practice Address - Street 1:7301 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1103
Practice Address - Country:US
Practice Address - Phone:727-424-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X, 222Q00000X, 251S00000X, 252Y00000X, 261QM0855X
FLMH6698101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0197221100Medicaid