Provider Demographics
NPI:1598205833
Name:FRISOSKY, KIMBERLEE RAE (BA)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:RAE
Last Name:FRISOSKY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SE FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2247
Mailing Address - Country:US
Mailing Address - Phone:269-275-3508
Mailing Address - Fax:
Practice Address - Street 1:306 SE FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2247
Practice Address - Country:US
Practice Address - Phone:269-275-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health