Provider Demographics
NPI:1780460196
Name:MENA, KIMBERLY ARLENE
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ARLENE
Last Name:MENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 NW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4049
Mailing Address - Country:US
Mailing Address - Phone:845-642-1572
Mailing Address - Fax:
Practice Address - Street 1:4313 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4049
Practice Address - Country:US
Practice Address - Phone:845-642-1572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health