Provider Demographics
NPI:1487945143
Name:CONCA, KERRY LYNN (MA)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:LYNN
Last Name:CONCA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14726 MORNING DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3217
Mailing Address - Country:US
Mailing Address - Phone:727-389-1374
Mailing Address - Fax:
Practice Address - Street 1:4902 EISENHOWER BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6310
Practice Address - Country:US
Practice Address - Phone:813-290-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health