Provider Demographics
NPI:1750435293
Name:RESSEL-HODAN, CLAUDIA J (PSYD)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:J
Last Name:RESSEL-HODAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 37TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1252
Mailing Address - Country:US
Mailing Address - Phone:727-399-0806
Mailing Address - Fax:727-399-9426
Practice Address - Street 1:3745 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7519
Practice Address - Country:US
Practice Address - Phone:727-399-0806
Practice Address - Fax:727-399-9426
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5343103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28185OtherWELLCARE
FL59842Medicare ID - Type Unspecified