Healthcare Provider Details

I. General information

NPI: 1780990531
Provider Name (Legal Business Name): KRISTINA JANET GREENFIELD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 N ATLANTIC AVE STE 430
COCOA BEACH FL
32931-3288
US

IV. Provider business mailing address

4750 PAWNEE TRL
MERRITT ISLAND FL
32953-7826
US

V. Phone/Fax

Practice location:
  • Phone: 321-345-9809
  • Fax:
Mailing address:
  • Phone: 321-345-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1434
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29371
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: