Provider Demographics
NPI:1043757594
Name:QUAKA, KRISTY (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:QUAKA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4181 NW 66TH PL
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2019
Mailing Address - Country:US
Mailing Address - Phone:561-306-0146
Mailing Address - Fax:
Practice Address - Street 1:4723 W ATLANTIC AVE STE A-21
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3895
Practice Address - Country:US
Practice Address - Phone:561-306-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health