Provider Demographics
NPI:1811029283
Name:WATERS KAKLAMANOS, KEELY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEELY
Middle Name:
Last Name:WATERS KAKLAMANOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KEELY
Other - Middle Name:
Other - Last Name:WATERS-KAKLAMANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1311 COVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-2504
Mailing Address - Country:US
Mailing Address - Phone:850-906-0331
Mailing Address - Fax:
Practice Address - Street 1:1664-2 METROPOLITAN CIRCLE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5413
Practice Address - Country:US
Practice Address - Phone:850-528-8895
Practice Address - Fax:850-385-1191
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7401103T00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TE1100X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily