Provider Demographics
NPI:1528183738
Name:GERARDI, CHARLES MICHAEL
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:GERARDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 EDGEWATER DR
Mailing Address - Street 2:UNIT 201
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6980
Mailing Address - Country:US
Mailing Address - Phone:727-483-4313
Mailing Address - Fax:727-953-9281
Practice Address - Street 1:620 EDGEWATER DR
Practice Address - Street 2:UNIT 201
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6980
Practice Address - Country:US
Practice Address - Phone:727-483-4313
Practice Address - Fax:727-953-9281
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54406Medicare ID - Type UnspecifiedPSYCHOLOGIST