Provider Demographics
NPI:1851727895
Name:GARES, EDDIE MARCELO (BS)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:MARCELO
Last Name:GARES
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-5113
Mailing Address - Country:US
Mailing Address - Phone:727-824-5738
Mailing Address - Fax:
Practice Address - Street 1:618 11TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-5113
Practice Address - Country:US
Practice Address - Phone:727-824-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health