Provider Demographics
NPI:1073165122
Name:MCNEIL, RAY ANTONIO (CAC, QMHP, RBT)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:ANTONIO
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:CAC, QMHP, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2919
Mailing Address - Country:US
Mailing Address - Phone:727-345-9111
Mailing Address - Fax:
Practice Address - Street 1:3190 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2919
Practice Address - Country:US
Practice Address - Phone:727-345-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5732101YA0400X
373H00000X
FLRBT-19-91278106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist