MEDICARE: KENNETH MATTHEW DECINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	MH20655	FL

General Provider Information

NPI Number	:	1841914918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH MATTHEW DECINA

Provider Business Mailing Address
First Line	:	3418 QUANTUM LAKES DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8340
Country	:	US
Telephone Number	:	954-937-1481
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 QUANTUM LAKES DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8340
Country	:	US
Telephone Number	:	954-937-1481
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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Directions to “ KENNETH MATTHEW DECINA ” Practice Location

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