Provider Demographics
NPI:1114162070
Name:KRISTY M FORARE PSYD LLC
Entity Type:Organization
Organization Name:KRISTY M FORARE PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:FORARE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:386-943-9040
Mailing Address - Street 1:1109 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-6553
Mailing Address - Country:US
Mailing Address - Phone:386-943-9040
Mailing Address - Fax:386-943-9937
Practice Address - Street 1:1109 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-6553
Practice Address - Country:US
Practice Address - Phone:386-943-9040
Practice Address - Fax:386-943-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty