Healthcare Provider Details

I. General information

NPI: 1376140202
Provider Name (Legal Business Name): KEVIN DALFONSO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 VENETIAN CT STE 1
NAPLES FL
34109-8727
US

IV. Provider business mailing address

2230 VENETIAN CT STE 1
NAPLES FL
34109-8727
US

V. Phone/Fax

Practice location:
  • Phone: 239-236-5448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: