Provider Demographics
NPI:1205363934
Name:NEAL, AMELIA (PSY S)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:PSY S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 45TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-3042
Mailing Address - Country:US
Mailing Address - Phone:727-350-1870
Mailing Address - Fax:
Practice Address - Street 1:1926 45TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-3042
Practice Address - Country:US
Practice Address - Phone:727-350-1870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 13618101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor