Provider Demographics
NPI:1609645159
Name:DOLPHY, KERI-ANN
Entity Type:Individual
Prefix:
First Name:KERI-ANN
Middle Name:
Last Name:DOLPHY
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 1:21 NORTHFLEET LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3142
Mailing Address - Country:US
Mailing Address - Phone:917-416-8072
Mailing Address - Fax:
Practice Address - Street 1:21 NORTHFLEET LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3142
Practice Address - Country:US
Practice Address - Phone:917-416-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker