Healthcare Provider Details

I. General information

NPI: 1619583085
Provider Name (Legal Business Name): MAGGY KARINA MEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 US HIGHWAY 27 STE 9
CLERMONT FL
34714-7508
US

IV. Provider business mailing address

708 ROBERT ST
KISSIMMEE FL
34741-4720
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0573
  • Fax: 407-650-3073
Mailing address:
  • Phone: 407-508-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19776
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: