Provider Demographics
NPI:1376521971
Name:KNEE, KATHLEEN
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:KNEE
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 1:40 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-6642
Mailing Address - Country:US
Mailing Address - Phone:954-489-0798
Mailing Address - Fax:954-923-5235
Practice Address - Street 1:300 S PINE ISLAND RD
Practice Address - Street 2:#263
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2673
Practice Address - Country:US
Practice Address - Phone:954-489-0788
Practice Address - Fax:954-370-7670
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4492103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96117OtherAETNA
FL73829Medicare ID - Type Unspecified