Provider Demographics
NPI:1104129576
Name:HARDY, KELVIN LEWIS (MS)
Entity type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:LEWIS
Last Name:HARDY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6114 GRAND CYPRESS CIR E
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2343
Mailing Address - Country:US
Mailing Address - Phone:800-253-0941
Mailing Address - Fax:
Practice Address - Street 1:6114 GRAND CYPRESS CIR E
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2343
Practice Address - Country:US
Practice Address - Phone:800-253-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health