Provider Demographics
NPI:1841906336
Name:PONCE, KARELY SARAHI
Entity type:Individual
Prefix:
First Name:KARELY
Middle Name:SARAHI
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 BALLENTINE CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1269
Mailing Address - Country:US
Mailing Address - Phone:863-409-8989
Mailing Address - Fax:
Practice Address - Street 1:4517 BALLENTINE CT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1269
Practice Address - Country:US
Practice Address - Phone:863-409-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst