MEDICARE: KELLY A DAMBRA LMHC

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH14626	OTHER	FL	DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1457852972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY A DAMBRA LMHC

Provider Business Mailing Address
First Line	:	914 S LAKE DR
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-4628
Country	:	US
Telephone Number	:	561-866-9776
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 OKEECHOBEE BLVD # 203
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4366
Country	:	US
Telephone Number	:	561-571-8164
Fax Number	:

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

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	09/30/2024

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