Provider Demographics
NPI:1649058314
Name:SMITH, KEDENE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:KEDENE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551532
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1532
Mailing Address - Country:US
Mailing Address - Phone:561-501-8069
Mailing Address - Fax:
Practice Address - Street 1:700 SW 78TH AVE APT 201
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3371
Practice Address - Country:US
Practice Address - Phone:561-501-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist