Healthcare Provider Details

I. General information

NPI: 1770067597
Provider Name (Legal Business Name): KIMBERLY WATTY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6971 N FEDERAL HWY STE 206
BOCA RATON FL
33487-1648
US

IV. Provider business mailing address

6971 N FEDERAL HWY STE 206
BOCA RATON FL
33487-1648
US

V. Phone/Fax

Practice location:
  • Phone: 561-408-1098
  • Fax: 561-408-1099
Mailing address:
  • Phone: 561-408-1098
  • Fax: 561-408-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: