MEDICARE: DR. KEELY WATERS KAKLAMANOS PH.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	103T00000X	Psychologist	PY7401	FL
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PY7401	FL
3	103TB0200X	Cognitive & Behavioral Psychologist	PY7401	FL
4	103TC0700X	Clinical Psychologist	PY7401	FL
5	103TC1900X	Counseling Psychologist	PY7401	FL
6	103TC2200X	Clinical Child & Adolescent Psychologist	PY7401	FL
7	103TE1100X	Exercise & Sports Psychologist	PY7401	FL
8	103TF0000X	Family Psychologist	PY7401	FL

General Provider Information

NPI Number	:	1811029283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEELY WATERS KAKLAMANOS PH.D.

Provider Business Mailing Address
First Line	:	1311 COVINGTON DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-2504
Country	:	US
Telephone Number	:	850-906-0331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1664-2 METROPOLITAN CIRCLE
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5413
Country	:	US
Telephone Number	:	850-528-8895
Fax Number	:	850-385-1191

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	05/07/2012

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