Provider Demographics
NPI:1417465162
Name:PETRIKAS, AIMIE (MA)
Entity Type:Individual
Prefix:
First Name:AIMIE
Middle Name:
Last Name:PETRIKAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 LAKE FRONT DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4451
Mailing Address - Country:US
Mailing Address - Phone:239-910-0848
Mailing Address - Fax:
Practice Address - Street 1:1940 MARAVILLA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7135
Practice Address - Country:US
Practice Address - Phone:239-334-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health