Healthcare Provider Details

I. General information

NPI: 1245524701
Provider Name (Legal Business Name): KRISTIE LEE DEBLASIO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIE DEBLASIO FEEHELY PHD

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 US HIGHWAY 1 SUITE 504
PALM BEACH GARDENS FL
33408
US

IV. Provider business mailing address

11760 US HIGHWAY 1 SUITE 504
PALM BEACH GARDENS FL
33408
US

V. Phone/Fax

Practice location:
  • Phone: 561-385-9996
  • Fax: 561-333-2122
Mailing address:
  • Phone: 561-385-9996
  • Fax: 561-333-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY8296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: