Healthcare Provider Details

I. General information

NPI: 1548740186
Provider Name (Legal Business Name): KENNETH T KRONHEIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 N STATE ROAD 7
LAUDERDALE LAKES FL
33319
US

IV. Provider business mailing address

4740 N STATE ROAD 7
LAUDERDALE LAKES FL
33319-5839
US

V. Phone/Fax

Practice location:
  • Phone: 954-606-0911
  • Fax: 954-497-3857
Mailing address:
  • Phone: 954-486-4005
  • Fax: 954-497-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMH9151
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: