Provider Demographics
NPI:1164733895
Name:DUPERVAL, KETTIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KETTIA
Middle Name:
Last Name:DUPERVAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 N OCEAN DR # 1011
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2920
Mailing Address - Country:US
Mailing Address - Phone:954-993-1646
Mailing Address - Fax:
Practice Address - Street 1:9730 GLACIER DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4407
Practice Address - Country:US
Practice Address - Phone:954-993-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW205781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical