Provider Demographics
NPI:1821689670
Name:RONEK, KATHRYN (MA, LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:RONEK
Suffix:
Gender:F
Credentials:MA, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8236 VILLA GRANDE CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3050
Mailing Address - Country:US
Mailing Address - Phone:314-640-6756
Mailing Address - Fax:
Practice Address - Street 1:5104 N LOCKWOOD RIDGE RD STE 105
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-3312
Practice Address - Country:US
Practice Address - Phone:314-640-6756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012038140101YP2500X
FLMH17580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional