Provider Demographics
NPI:1205080884
Name:FORARE, KRISTY MILLER (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:MILLER
Last Name:FORARE
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 1:1109 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-6553
Mailing Address - Country:US
Mailing Address - Phone:386-943-9040
Mailing Address - Fax:386-943-9937
Practice Address - Street 1:1109 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-6553
Practice Address - Country:US
Practice Address - Phone:386-943-9040
Practice Address - Fax:386-943-9937
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical