MEDICARE: DR. KENNETH CHRISTIANSEN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)	PY5813	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366542078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH CHRISTIANSEN PSY.D.

Provider Business Mailing Address
First Line	:	407 LINCOLN RD
Second Line	:	STE 306
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3038
Country	:	US
Telephone Number	:	305-672-1104
Fax Number	:	305-672-1385

Provider Business Practice Location Address
First Line	:	407 LINCOLN RD
Second Line	:	#6K
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3020
Country	:	US
Telephone Number	:	305-675-1104
Fax Number	:	305-672-1385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	12/15/2016

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