Provider Demographics
NPI:1356085369
Name:KAISER, LETICIA MICHELLE
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:MICHELLE
Last Name:KAISER
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 1:1516 E COLONIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4726
Mailing Address - Country:US
Mailing Address - Phone:407-894-1708
Mailing Address - Fax:407-894-1780
Practice Address - Street 1:1516 E COLONIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4726
Practice Address - Country:US
Practice Address - Phone:407-894-1708
Practice Address - Fax:407-894-1780
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health