MEDICARE: KATHRYN EVE KRISTOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW20236	FL

General Provider Information

NPI Number	:	1427677814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN EVE KRISTOL

Provider Business Mailing Address
First Line	:	4156 NW 55TH PL
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2771
Country	:	US
Telephone Number	:	954-798-2055
Fax Number	:

Provider Business Practice Location Address
First Line	:	4156 NW 55TH PL
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2771
Country	:	US
Telephone Number	:	954-798-2055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	01/21/2026

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