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General NPI Number Information
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NPI Number | 1417195306
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Entity Type | Organization
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Legal Business Name | KRISTINA MCMENAMY PSYD LLC
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 1845 CYPRESS LAKE DR
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City | GRANT
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State | FL
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Zip | 32949-5330
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Country | US
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Telephone | 772-607-2293
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 CYPRESS LAKE DR
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City | GRANT
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State | FL
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Zip | 32949-5330
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Country | US
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Telephone | 772-607-2293
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KRISTINA ANNE MCMENAMY
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Credential | PSYD
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Telephone | 772-607-2293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7481
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License Number State | FL
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