Basic Information
Provider Information
NPI: 1487227393
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHAVE
FirstName: ERIC
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 10970
Address2:  
City: ST PETERSBURG
State: FL
PostalCode: 337330970
CountryCode: US
TelephoneNumber: 7273277656
FaxNumber: 7273222103
Practice Location
Address1: 2960 ROOSEVELT BLVD
Address2:  
City: CLEARWATER
State: FL
PostalCode: 337601952
CountryCode: US
TelephoneNumber: 7273277656
FaxNumber: 7273222103
Other Information
ProviderEnumerationDate: 07/19/2021
LastUpdateDate: 07/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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