Individual
DR. KIM DEFFEBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1101 RIVER RD, MELBOURNE BEACH, FL 32951-2533
(321) 223-0147
Mailing address
1101 RIVER RD, MELBOURNE BEACH, FL 32951-2533
(321) 223-0147
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY 6195
FL
Other
Enumeration date
04/20/2007
Last updated
07/08/2007
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