Provider Demographics
NPI:1720362544
Name:GEDAJLOVIC, SARA L (LMHC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:GEDAJLOVIC
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 SNELL ISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3830
Mailing Address - Country:US
Mailing Address - Phone:727-743-3483
Mailing Address - Fax:727-896-7272
Practice Address - Street 1:930 SNELL ISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3830
Practice Address - Country:US
Practice Address - Phone:727-743-3483
Practice Address - Fax:727-896-7272
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3061101YM0800X, 101YP2500X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761456000Medicaid