Provider Demographics
NPI:1881020212
Name:HEMINGWAY, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:HEMINGWAY
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 1:1147 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1104
Mailing Address - Country:US
Mailing Address - Phone:727-824-5735
Mailing Address - Fax:727-824-5734
Practice Address - Street 1:1147 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1104
Practice Address - Country:US
Practice Address - Phone:727-824-5735
Practice Address - Fax:727-824-5734
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health