Provider Demographics
NPI:1023327459
Name:GIRARDOT, KRISTIN PATRICE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:PATRICE
Last Name:GIRARDOT
Suffix:
Gender:F
Credentials:PHD
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 547878
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32854-7878
Mailing Address - Country:US
Mailing Address - Phone:407-808-7852
Mailing Address - Fax:
Practice Address - Street 1:500 N MAITLAND AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4482
Practice Address - Country:US
Practice Address - Phone:407-808-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6292103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical