Provider Demographics
NPI:1437217742
Name:PIERCE, KELLY D (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:D
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:PIERCE
Other - Last Name:PINEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1045 E ATLANTIC AVENUE
Mailing Address - Street 2:#205
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-6909
Mailing Address - Country:US
Mailing Address - Phone:561-727-6858
Mailing Address - Fax:
Practice Address - Street 1:1045 E ATLANTIC AVENUE
Practice Address - Street 2:#205
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6909
Practice Address - Country:US
Practice Address - Phone:561-727-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766173800Medicaid