Provider Demographics
NPI:1861770109
Name:TALBOT, KRISTINA JEFFRIES (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:JEFFRIES
Last Name:TALBOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 ORANGE BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6951
Mailing Address - Country:US
Mailing Address - Phone:321-431-9334
Mailing Address - Fax:
Practice Address - Street 1:856 ORANGE BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6951
Practice Address - Country:US
Practice Address - Phone:321-431-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-803582101YA0400X
FLSW100051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003938900Medicaid
FL003938900Medicaid