Healthcare Provider Details

I. General information

NPI: 1366542078
Provider Name (Legal Business Name): KENNETH CHRISTIANSEN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 LINCOLN RD #6K
MIAMI BEACH FL
33139-3020
US

IV. Provider business mailing address

407 LINCOLN RD STE 306
MIAMI BEACH FL
33139-3038
US

V. Phone/Fax

Practice location:
  • Phone: 305-675-1104
  • Fax: 305-672-1385
Mailing address:
  • Phone: 305-672-1104
  • Fax: 305-672-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberPY5813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: