Provider Demographics
NPI:1447608708
Name:METCALF, DINAH
Entity Type:Individual
Prefix:
First Name:DINAH
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 OMAHA ST
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4427
Mailing Address - Country:US
Mailing Address - Phone:727-460-8334
Mailing Address - Fax:
Practice Address - Street 1:624 OMAHA ST
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4427
Practice Address - Country:US
Practice Address - Phone:727-460-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 11396101YM0800X
FLIMT 2090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist