Healthcare Provider Details

I. General information

NPI: 1376794610
Provider Name (Legal Business Name): SARAH KATHERINE KUYKENDALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 JULIA ST UNIT 100
NEW SMYRNA BEACH FL
32168-7713
US

IV. Provider business mailing address

136 JULIA ST UNIT 100
NEW SMYRNA BEACH FL
32168-7713
US

V. Phone/Fax

Practice location:
  • Phone: 386-423-9161
  • Fax: 386-423-3094
Mailing address:
  • Phone: 386-423-9161
  • Fax: 386-423-3094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1958
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13079
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: