Provider Demographics
NPI:1235645748
Name:JANICA, KRISTEN LEE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE
Last Name:JANICA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LEE
Other - Last Name:NARDOLILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7 LIVE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:YALAHA
Mailing Address - State:FL
Mailing Address - Zip Code:34797
Mailing Address - Country:US
Mailing Address - Phone:352-234-6134
Mailing Address - Fax:321-256-0307
Practice Address - Street 1:3601 SOLANA CIRCLE
Practice Address - Street 2:UNIT D
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-234-6134
Practice Address - Fax:407-583-6487
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW177691041C0700X
FLISW11163104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISW11163OtherFLORIDA DEPARTMENT OF HEALTH