Provider Demographics
NPI:1417537119
Name:BRESLIN, KRISTEN (MS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:BRESLIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 OAKLAND SHORES DR APT H112
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5662
Mailing Address - Country:US
Mailing Address - Phone:954-368-1344
Mailing Address - Fax:
Practice Address - Street 1:3101 OAKLAND SHORES DR APT H112
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-5662
Practice Address - Country:US
Practice Address - Phone:954-368-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty