Provider Demographics
NPI:1295051175
Name:ATTAWAY, KATHLEEN GINN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GINN
Last Name:ATTAWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:GINN
Other - Last Name:FIORELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1850 PROVIDENCE LAKES BLVD
Mailing Address - Street 2:#1121
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-1880
Mailing Address - Country:US
Mailing Address - Phone:813-361-2755
Mailing Address - Fax:
Practice Address - Street 1:2223 SHADEHILL CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5024
Practice Address - Country:US
Practice Address - Phone:813-495-4773
Practice Address - Fax:813-935-4771
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW50701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical