Provider Demographics
NPI:1457342081
Name:TERRY, KRISTINE ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:TERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13750 W COLONIAL DR STE 350
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6148
Mailing Address - Country:US
Mailing Address - Phone:570-287-1301
Mailing Address - Fax:
Practice Address - Street 1:566 W BAY ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2631
Practice Address - Country:US
Practice Address - Phone:570-287-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008326L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA815349OtherFIRST PRIORITY
PA2101564OtherCIGNA BEH HEALTH
PA815349OtherFIRST PRIORITY