Provider Demographics
NPI:1649615428
Name:KLITENICK, JUDIE LIPNER
Entity type:Individual
Prefix:MRS
First Name:JUDIE
Middle Name:LIPNER
Last Name:KLITENICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDIE
Other - Middle Name:
Other - Last Name:LIPNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1319 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4736
Mailing Address - Country:US
Mailing Address - Phone:305-294-4263
Mailing Address - Fax:305-292-9466
Practice Address - Street 1:1319 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4736
Practice Address - Country:US
Practice Address - Phone:305-294-4263
Practice Address - Fax:305-292-9466
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW54521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical