Provider Demographics
NPI:1609398379
Name:FABRIZI, KRISTEN (PSYD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:FABRIZI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 S FLORIDA AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4904
Mailing Address - Country:US
Mailing Address - Phone:863-701-9202
Mailing Address - Fax:863-701-9262
Practice Address - Street 1:5300 S FLORIDA AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4904
Practice Address - Country:US
Practice Address - Phone:863-701-9202
Practice Address - Fax:863-701-9262
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12465103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical