Healthcare Provider Details

I. General information

NPI: 1780460196
Provider Name (Legal Business Name): MS. KIMBERLY ARLENE MENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2883 N FOLKESTONE LOOP
HERNANDO FL
34442-5462
US

IV. Provider business mailing address

2883 N FOLKESTONE LOOP
HERNANDO FL
34442-5462
US

V. Phone/Fax

Practice location:
  • Phone: 845-642-1572
  • Fax:
Mailing address:
  • Phone: 845-642-1572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH26913
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101287
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: