Provider Demographics
NPI:1093107179
Name:PAINTER, KARIN
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:PAINTER
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 1:2680 REVOLUTION ST
Mailing Address - Street 2:#103
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7701
Mailing Address - Country:US
Mailing Address - Phone:321-543-1185
Mailing Address - Fax:
Practice Address - Street 1:2680 REVOLUTION ST
Practice Address - Street 2:#103
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7701
Practice Address - Country:US
Practice Address - Phone:321-543-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health