Provider Demographics
NPI:1558627695
Name:TENUKAS-STEBLEA, KATHLEEN WANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:WANDA
Last Name:TENUKAS-STEBLEA
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 1:154 BRYN MAWR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6312
Mailing Address - Country:US
Mailing Address - Phone:561-547-5219
Mailing Address - Fax:
Practice Address - Street 1:154 BRYN MAWR DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-6312
Practice Address - Country:US
Practice Address - Phone:561-547-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 38061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical