MEDICARE: MS. KAITLYN SFERRAZZA 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	MH22199	FL

General Provider Information

NPI Number	:	1669161386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAITLYN SFERRAZZA LMHC

Provider Business Mailing Address
First Line	:	30190 US HIGHWAY 19 N # 1044
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-1044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3578 PARK ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1048
Country	:	US
Telephone Number	:	727-871-3436
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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