Individual
KELLY HABYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
2100 SE HILLMOOR DR STE 104, PORT ST LUCIE, FL 34952-8057
(772) 380-9972
(772) 380-9976
Mailing address
2100 SE HILLMOOR DR STE 104, PORT ST LUCIE, FL 34952-8057
(772) 380-9972
(772) 380-9976
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113781100
—
FL
05
—
768088100
—
FL
05
—
811866300
—
FL
Enumeration date
03/23/2007
Last updated
12/21/2022
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