Provider Demographics
NPI:1619417250
Name:LUMINARA VINDI LLC
Entity Type:Organization
Organization Name:LUMINARA VINDI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-906-6185
Mailing Address - Street 1:300 2ND AVE SOUTH EAST
Mailing Address - Street 2:#83
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2023
Mailing Address - Country:US
Mailing Address - Phone:727-906-6185
Mailing Address - Fax:
Practice Address - Street 1:300 2ND AVE SOUTH EAST #83
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3370
Practice Address - Country:US
Practice Address - Phone:727-906-6185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty