Provider Demographics
NPI:1225377013
Name:KEPLER, IRENE M (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:IRENE
Middle Name:M
Last Name:KEPLER
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 1:6039 POMPANO ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4408
Mailing Address - Country:US
Mailing Address - Phone:586-879-5129
Mailing Address - Fax:
Practice Address - Street 1:6039 POMPANO ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4408
Practice Address - Country:US
Practice Address - Phone:586-879-5129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010866481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical