Provider Demographics
NPI:1922195957
Name:QUIRK, JERI (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:
Last Name:QUIRK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SEMINOLE BLVD
Mailing Address - Street 2:SUITE K
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3378
Mailing Address - Country:US
Mailing Address - Phone:727-395-0544
Mailing Address - Fax:
Practice Address - Street 1:5200 SEMINOLE BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-3378
Practice Address - Country:US
Practice Address - Phone:727-395-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8222101YM0800X
MA4808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health