Provider Demographics
NPI:1245524701
Name:DEBLASIO, KRISTIE LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:LEE
Last Name:DEBLASIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:DEBLASIO
Other - Last Name:FEEHELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:11760 US HIGHWAY 1
Mailing Address - Street 2:SUITE 504
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33408
Mailing Address - Country:US
Mailing Address - Phone:561-385-9996
Mailing Address - Fax:561-333-2122
Practice Address - Street 1:11760 US HIGHWAY 1
Practice Address - Street 2:SUITE 504
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33408
Practice Address - Country:US
Practice Address - Phone:561-385-9996
Practice Address - Fax:561-333-2122
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8296103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical