Healthcare Provider Details

I. General information

NPI: 1134516040
Provider Name (Legal Business Name): KATHLYN NEAL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LAKE DESTINY TRL
ALTAMONTE SPRINGS FL
32714-3455
US

IV. Provider business mailing address

501 N ORLANDO AVE STE 313-415
WINTER PARK FL
32789-7313
US

V. Phone/Fax

Practice location:
  • Phone: 407-495-1548
  • Fax:
Mailing address:
  • Phone: 407-495-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW60336229
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: