Provider Demographics
NPI:1528898756
Name:FEDERICO, KAMRYN
Entity type:Individual
Prefix:
First Name:KAMRYN
Middle Name:
Last Name:FEDERICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 GARRETT ST
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6640
Mailing Address - Country:US
Mailing Address - Phone:561-990-9851
Mailing Address - Fax:
Practice Address - Street 1:12780 WATERFORD LAKES PKWY STE 127
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4501
Practice Address - Country:US
Practice Address - Phone:407-848-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-362492106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician