Provider Demographics
NPI:1750573135
Name:ICM ASSOCIATES, INC.
Entity type:Organization
Organization Name:ICM ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:CARAVELLA
Authorized Official - Suffix:
Authorized Official - Credentials:CAC, NCAC1, BRI-1
Authorized Official - Phone:727-392-5600
Mailing Address - Street 1:15454 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1803
Mailing Address - Country:US
Mailing Address - Phone:727-392-5600
Mailing Address - Fax:727-499-7517
Practice Address - Street 1:900 CARILLON PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1115
Practice Address - Country:US
Practice Address - Phone:727-392-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4013A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health