Provider Demographics
NPI:1699118596
Name:KINTZ, KELLIE L
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:L
Last Name:KINTZ
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 1:250 JOHN F KENNEDY DR APT 304
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6605
Mailing Address - Country:US
Mailing Address - Phone:561-704-6063
Mailing Address - Fax:
Practice Address - Street 1:250 JOHN F KENNEDY DR APT 304
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6605
Practice Address - Country:US
Practice Address - Phone:561-704-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW85251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical