Provider Demographics
NPI:1366542078
Name:CHRISTIANSEN, KENNETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 LINCOLN RD
Mailing Address - Street 2:STE 306
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3038
Mailing Address - Country:US
Mailing Address - Phone:305-672-1104
Mailing Address - Fax:305-672-1385
Practice Address - Street 1:407 LINCOLN RD
Practice Address - Street 2:#6K
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3020
Practice Address - Country:US
Practice Address - Phone:305-675-1104
Practice Address - Fax:305-672-1385
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5813170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS