MEDICARE: MIRTA MARTINEZ-KEKENAK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	098833	NY

General Provider Information

NPI Number	:	1033373501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRTA MARTINEZ-KEKENAK LCSW

Provider Business Mailing Address
First Line	:	12360 66TH ST # Y3
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-3434
Country	:	US
Telephone Number	:	727-558-1344
Fax Number	:

Provider Business Practice Location Address
First Line	:	12360 66TH ST # Y3
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-3434
Country	:	US
Telephone Number	:	727-558-1344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	01/09/2026

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Directions to “ MIRTA MARTINEZ-KEKENAK LCSW” Practice Location

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