Provider Demographics
NPI:1396486189
Name:REIDELL, KALENE NOELLE
Entity type:Individual
Prefix:
First Name:KALENE
Middle Name:NOELLE
Last Name:REIDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALENE
Other - Middle Name:NOELLE
Other - Last Name:BUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 LAUGHING GULL DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5539
Mailing Address - Country:US
Mailing Address - Phone:570-412-2682
Mailing Address - Fax:
Practice Address - Street 1:5768 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-4818
Practice Address - Country:US
Practice Address - Phone:407-896-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCG61283691101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCMHP.0100133OtherCMHP