Provider Demographics
NPI:1841914918
Name:DECINA, KENNETH MATTHEW
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:MATTHEW
Last Name:DECINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 QUANTUM LAKES DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8340
Mailing Address - Country:US
Mailing Address - Phone:954-937-1481
Mailing Address - Fax:
Practice Address - Street 1:3418 QUANTUM LAKES DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8340
Practice Address - Country:US
Practice Address - Phone:954-937-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20655101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor