Provider Demographics
NPI:1033373501
Name:MARTINEZ-KEKENAK, MIRTA (LCSW)
Entity type:Individual
Prefix:
First Name:MIRTA
Middle Name:
Last Name:MARTINEZ-KEKENAK
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 1:12360 66TH ST # Y3
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3434
Mailing Address - Country:US
Mailing Address - Phone:727-558-1344
Mailing Address - Fax:
Practice Address - Street 1:12360 66TH ST # Y3
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3434
Practice Address - Country:US
Practice Address - Phone:727-558-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker