Provider Demographics
NPI:1225650021
Name:CORONEL, KELLY ANNE (LMHC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:CORONEL
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 1:5155 44TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2972
Mailing Address - Country:US
Mailing Address - Phone:941-500-4082
Mailing Address - Fax:
Practice Address - Street 1:66 W FLAGLER ST STE 900
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1807
Practice Address - Country:US
Practice Address - Phone:941-500-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health