Provider Demographics
NPI:1730302969
Name:BRESLAW, KRISTY RINI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:RINI
Last Name:BRESLAW
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 1:229 GEORGE BUSH BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-4034
Mailing Address - Country:US
Mailing Address - Phone:561-272-1234
Mailing Address - Fax:561-994-5979
Practice Address - Street 1:229 GEORGE BUSH BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-4034
Practice Address - Country:US
Practice Address - Phone:561-272-1234
Practice Address - Fax:561-994-5979
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7258103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist