Provider Demographics
NPI:1427677814
Name:KRISTOL, KATHRYN EVE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EVE
Last Name:KRISTOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 NW 55TH PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2771
Mailing Address - Country:US
Mailing Address - Phone:954-798-2055
Mailing Address - Fax:
Practice Address - Street 1:4156 NW 55TH PL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2771
Practice Address - Country:US
Practice Address - Phone:954-798-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLSW20236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health