Provider Demographics
NPI:1225627334
Name:BARTOLINO, ANTHONY FLORIANO (MS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FLORIANO
Last Name:BARTOLINO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 KINGSLEY AVE
Mailing Address - Street 2:ST.2
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-375-8388
Mailing Address - Fax:
Practice Address - Street 1:2140 KINGSLEY AVE
Practice Address - Street 2:ST.2
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3207
Practice Address - Country:US
Practice Address - Phone:904-375-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health