Provider Demographics
NPI:1689101339
Name:SUMMERVILLE, TONIETT
Entity Type:Individual
Prefix:
First Name:TONIETT
Middle Name:
Last Name:SUMMERVILLE
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 1:1232 ROSEGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-1820
Mailing Address - Country:US
Mailing Address - Phone:561-603-5689
Mailing Address - Fax:
Practice Address - Street 1:1232 ROSEGATE BLVD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-1820
Practice Address - Country:US
Practice Address - Phone:561-603-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health