Provider Demographics
NPI:1619583085
Name:MEAD, MAGGY KARINA
Entity Type:Individual
Prefix:
First Name:MAGGY
Middle Name:KARINA
Last Name:MEAD
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 1:708 ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4720
Mailing Address - Country:US
Mailing Address - Phone:407-508-2244
Mailing Address - Fax:
Practice Address - Street 1:1050 US HIGHWAY 27 STE 9
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7508
Practice Address - Country:US
Practice Address - Phone:352-394-0573
Practice Address - Fax:407-650-3073
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty