Provider Demographics
NPI:1134316995
Name:KIEFFER, KEVIN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:KIEFFER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19513 COACHLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4037
Mailing Address - Country:US
Mailing Address - Phone:352-588-8306
Mailing Address - Fax:352-588-8300
Practice Address - Street 1:33701 STATE ROAD 52
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY MC 2127
Practice Address - City:SAINT LEO
Practice Address - State:FL
Practice Address - Zip Code:33574-6665
Practice Address - Country:US
Practice Address - Phone:352-588-8306
Practice Address - Fax:352-588-8300
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist