Provider Demographics
NPI:1417119132
Name:LUBIN-JNO BAPTISTE, KERLY
Entity Type:Individual
Prefix:MRS
First Name:KERLY
Middle Name:
Last Name:LUBIN-JNO BAPTISTE
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 1:5500 MURRELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6700
Mailing Address - Country:US
Mailing Address - Phone:866-610-0580
Mailing Address - Fax:321-593-0839
Practice Address - Street 1:175 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3625
Practice Address - Country:US
Practice Address - Phone:866-610-0580
Practice Address - Fax:407-588-6294
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician