Healthcare Provider Details

I. General information

NPI: 1619660420
Provider Name (Legal Business Name): DIANNA KALPAKIAN, PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15362 SWEET SPRINGS BND
ODESSA FL
33556-2943
US

IV. Provider business mailing address

15362 SWEET SPRINGS BND
ODESSA FL
33556-2943
US

V. Phone/Fax

Practice location:
  • Phone: 727-773-5669
  • Fax:
Mailing address:
  • Phone: 727-773-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DIANNA MARY KALPAKIAN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 727-773-5669