Mary Alston Kerllenevich, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY 7744 Issued in FL

Legal business name

MARY ALSTON KERLLENEVICH, LLC

Practice address

1100 S Ponce de Leon Blvd Ste 1
St Augustine, FL 32084-6013

Phone

(904) 824-7733

Fax

(904) 829-9768

NPI assigned

Nov 19, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary A Kerllenevich, PH.D.

Title

MGRM

Phone

(904) 824-7733

Specialties & licenses 1

Addresses

Other names 1

• Mary Alston Kerllenevich, Ph.D. Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227052800000",
    "number": "1033364971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 US HIGHWAY 1 N",
            "address_2": "SUITE 400",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320956271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S PONCE DE LEON BLVD STE 1",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320846013",
            "telephone_number": "904-824-7733",
            "fax_number": "904-829-9768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY ALSTON KERLLENEVICH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-19",
        "last_updated": "2008-11-19",
        "status": "A",
        "authorized_official_last_name": "KERLLENEVICH",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MGRM",
        "authorized_official_telephone_number": "904-824-7733",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY 7744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Alston Kerllenevich, Ph.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cody Martyn, RPH
• Sarah Martyn
• Trask Albert James Martyn, PHARMD
• Nino Maruashvili
• Margaret Marutov, DPT
• Mary West
• Anna Marzak
• Miguel A Mas Jr., MD
• Mason H Long MD PA
• Caitlin Mason, SLP

• Psychologist in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.