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General NPI Number Information
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NPI Number | 1134316995
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Entity Type | Individual
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Provider Name | KEVIN M. KIEFFER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 33701 STATE ROAD 52 DEPARTMENT OF PSYCHOLOGY MC 2127
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City | SAINT LEO
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State | FL
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Zip | 33574-6665
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Country | US
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Telephone | 352-588-8306
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Fax | 352-588-8300
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Provider Business Mailing Address
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Address Line | 19513 COACHLIGHT WAY
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City | LUTZ
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State | FL
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Zip | 33549-4037
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Country | US
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Telephone | 352-588-8306
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Fax | 352-588-8300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY6615
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License Number State | FL
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