Provider Demographics
NPI:1518632645
Name:GUADAGNI, KERRI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:
Last Name:GUADAGNI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 RIVOCEAN DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-3223
Mailing Address - Country:US
Mailing Address - Phone:631-921-0630
Mailing Address - Fax:
Practice Address - Street 1:200 S HARBOR CITY BLVD STE 401
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1389
Practice Address - Country:US
Practice Address - Phone:321-259-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11166103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty