Provider Demographics
NPI:1760529259
Name:HADRIKA, KURT MITCHELL (MS)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:MITCHELL
Last Name:HADRIKA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7491 CONROY WINDERMERE RD STE K
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2769
Mailing Address - Country:US
Mailing Address - Phone:407-521-1750
Mailing Address - Fax:407-521-1708
Practice Address - Street 1:7491 CONROY WINDERMERE RD STE K
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2769
Practice Address - Country:US
Practice Address - Phone:407-521-1750
Practice Address - Fax:407-521-1708
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist