Provider Demographics
NPI:1770201527
Name:GEROW, KRISTEL MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTEL
Middle Name:MARIE
Last Name:GEROW
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 1:278 SEABREEZE CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-6438
Mailing Address - Country:US
Mailing Address - Phone:719-331-0332
Mailing Address - Fax:
Practice Address - Street 1:278 SEABREEZE CIR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-6438
Practice Address - Country:US
Practice Address - Phone:719-331-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00014707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1689150187OtherUNKNOWN