| Organization Name: | KRISTY M FORARE PSYD LLC |
| NPI Number: | 1114162070 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KRISTY MILLER FORARE (PRESIDENT) |
| Mailing Address: | 1109 W Euclid Ave Deland |
| State: | FL US |
| Postal Code: | 327206553 |
| Phone Number: | 3869439040 |
| Fax Number: | 3869439937 |
| NPI Enumeration Date: | 12/08/2008 |
| NPI Last Update Date: | 12/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY7031 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |