Provider Demographics
NPI:1306929831
Name:GEORGE, JEFFREY M (PSYD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 2ND ST N
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3517
Mailing Address - Country:US
Mailing Address - Phone:727-725-8820
Mailing Address - Fax:
Practice Address - Street 1:801 2ND ST N
Practice Address - Street 2:SUITE 7
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3517
Practice Address - Country:US
Practice Address - Phone:727-725-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0006361103TC0700X
LA796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54722XMedicare ID - Type Unspecified