Provider Demographics
NPI:1457933038
Name:LAFFERMAN, KELLY (RCMHI)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LAFFERMAN
Suffix:
Gender:F
Credentials:RCMHI
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 1229
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-1229
Mailing Address - Country:US
Mailing Address - Phone:407-900-8633
Mailing Address - Fax:
Practice Address - Street 1:37 N ORANGE AVE STE 1100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2449
Practice Address - Country:US
Practice Address - Phone:407-900-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1851845523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1851845523OtherORLANDO HEALTH NETWORK
FL81-3510306OtherORLANDO HEALTH NETWORK