Individual
KRISTINE MARIE RODRIGUEZ PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
145 HERON BAY RD, JACKSONVILLE, FL 32218-3595
(352) 548-6000
Mailing address
145 HERON BAY RD, JACKSONVILLE, FL 32218-3595
(352) 548-6000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
12327
MA
103T00000X
Psychologist
11615
MA
103T00000X
Psychologist
Primary
PSY004550
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042622756
CCA
MA
01
—
1134107113
MBHP
MA
05
—
1134107113
—
MA
01
—
12529
HNE
MA
01
—
71756
TUFTS
MA
01
—
997303
NETWORK HEALTH
MA
01
—
Y10086
MEDICARE
MA
Enumeration date
03/04/2019
Last updated
12/06/2024
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