Provider Demographics
NPI:1780990531
Name:GREENFIELD, KRISTINA JANET (PSYD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JANET
Last Name:GREENFIELD
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 1:4750 PAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-7826
Mailing Address - Country:US
Mailing Address - Phone:321-345-9809
Mailing Address - Fax:
Practice Address - Street 1:1980 N ATLANTIC AVE STE 430
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3288
Practice Address - Country:US
Practice Address - Phone:321-345-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1434103TS0200X
CAPSY29371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool