Provider Demographics
NPI:1306994736
Name:KAFANTARIS, KATHLEEN REED (LISW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:REED
Last Name:KAFANTARIS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5773 ALAMOSA CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-3101
Mailing Address - Country:US
Mailing Address - Phone:904-517-9531
Mailing Address - Fax:904-490-9650
Practice Address - Street 1:8825 PERIMETER PARK BLVD STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1112
Practice Address - Country:US
Practice Address - Phone:904-517-9531
Practice Address - Fax:904-490-9650
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.08003761041C0700X
FLSW152411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical