Healthcare Provider Details

I. General information

NPI: 1467841908
Provider Name (Legal Business Name): KENYATTA CONNAWAY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 FORUM PL SUITE 7
WEST PALM BEACH FL
33401-2330
US

IV. Provider business mailing address

2320 AVENUE S
RIVIERA BEACH FL
33404-4033
US

V. Phone/Fax

Practice location:
  • Phone: 561-712-8821
  • Fax: 561-712-8070
Mailing address:
  • Phone: 561-584-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: