Healthcare Provider Details

I. General information

NPI: 1568622496
Provider Name (Legal Business Name): KYLEE AMBER FITTIPALDI MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 NE SAVANNAH RD
JENSEN BEACH FL
34957-3805
US

IV. Provider business mailing address

1129 LINCOLN BLVD APT 2
SANTA MONICA CA
90403-5231
US

V. Phone/Fax

Practice location:
  • Phone: 772-334-0701
  • Fax:
Mailing address:
  • Phone: 772-224-6916
  • Fax:

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: