Mary Jane Jedi Kmak, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW27059 Issued in FL

Practice address

1777 Tamiami TRL Ste 500
Port Charlotte, FL 33948-1083

Phone

(941) 780-4268

NPI assigned

Nov 2, 2026

Last updated

Nov 2, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1793577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1793577600000",
    "number": "1821997537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2309 FINTONROD ST",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339483410",
            "telephone_number": "954-815-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 TAMIAMI TRL STE 500",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481083",
            "telephone_number": "941-780-4268"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14868 Tamiami Trl Unit A-203",
            "address_purpose": "LOCATION",
            "city": "North Port",
            "state": "FL",
            "postal_code": "342872701",
            "country_code": "US",
            "telephone_number": "941-780-4268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KMAK",
        "first_name": "MARY JANE",
        "middle_name": "JEDI",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-11-02",
        "last_updated": "2026-11-02",
        "certification_date": "2026-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW27059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Kipfinger
• Linda Hu Kishtok, SLP
• Alexandra Kitchener, APRN
• Alyssa Michelle Klein, MSN FNP-BC
• Joanna Madonna Kluesner, OD
• Janie Knight, M.S. CCC-SLP
• Nicholas M Koch, RPHT
• Janice M Koontz, RPH
• George Cyriac Koppuzha, MD
• Nathan Koranteng, ACNP-BC

• Clinical Social Worker in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.