Healthcare Provider Details

I. General information

NPI: 1912916503
Provider Name (Legal Business Name): KRISTEN ANN PUTERBAUGH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 CENTRAL AVE
ST PETERSBURG FL
33711-1239
US

IV. Provider business mailing address

13250 RIDGE RD APT 3A3
LARGO FL
33778-1829
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-7656
  • Fax:
Mailing address:
  • Phone: 727-742-0580
  • Fax: 727-393-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW3473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: