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General NPI Number Information
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NPI Number | 1497131544
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Entity Type | Individual
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Provider Name | DIANE M KEDZIERSKI PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 10768 SW 67TH TER
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City | OCALA
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State | FL
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Zip | 34476-4761
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Country | US
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Telephone | 352-300-0321
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Fax | 352-509-4257
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Provider Business Mailing Address
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Address Line | 10768 SW 67TH TER
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City | OCALA
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State | FL
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Zip | 34476-4761
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Country | US
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Telephone | 352-300-0321
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Fax | 352-509-4257
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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 | B1-0011401
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY9729
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License Number State | FL
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