Provider Demographics
NPI:1932592938
Name:EDGHILL, KENAYA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KENAYA
Middle Name:M
Last Name:EDGHILL
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:PO BOX 1798
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33731-1798
Mailing Address - Country:US
Mailing Address - Phone:727-269-9416
Mailing Address - Fax:
Practice Address - Street 1:8022 OLD COUNTY ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6409
Practice Address - Country:US
Practice Address - Phone:727-784-8244
Practice Address - Fax:727-264-8802
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW125201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical