Provider Demographics
NPI:1972865855
Name:PONZIO, KRISTEN ANN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ANN
Last Name:PONZIO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:INTERCESSION CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33848-0809
Mailing Address - Country:US
Mailing Address - Phone:407-846-5294
Mailing Address - Fax:407-846-5298
Practice Address - Street 1:5051 NORTH LN
Practice Address - Street 2:SUITE 21
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-2088
Practice Address - Country:US
Practice Address - Phone:407-846-5294
Practice Address - Fax:407-846-5298
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health