Provider Demographics
NPI:1205937166
Name:DE LA PENA, KETTY (LCSW)
Entity type:Individual
Prefix:
First Name:KETTY
Middle Name:
Last Name:DE LA PENA
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 1:18302 HIGHWOODS PARKWAY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:727-934-3223
Mailing Address - Fax:
Practice Address - Street 1:18302 HIGHWOODS PARKWAY
Practice Address - Street 2:SUITE 114
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647
Practice Address - Country:US
Practice Address - Phone:727-934-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6553YMedicare ID - Type Unspecified