Provider Demographics
NPI:1750803029
Name:DEMPSEY, PAUL KENNETH (LCSW MCAP ICADC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:KENNETH
Last Name:DEMPSEY
Suffix:
Gender:M
Credentials:LCSW MCAP ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 SE NOME DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-8952
Mailing Address - Country:US
Mailing Address - Phone:772-342-7802
Mailing Address - Fax:
Practice Address - Street 1:463 SE NOME DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-8952
Practice Address - Country:US
Practice Address - Phone:772-342-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW12702101Y00000X, 104100000X, 1041C0700X
FLMCAP100135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker