Provider Demographics
NPI:1033266168
Name:HARVEY, BEVERLY YVETTE (ITDS)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:YVETTE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:Y
Other - Last Name:ROSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2719 COBBLESTONE FOREST CIR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5760
Mailing Address - Country:US
Mailing Address - Phone:904-641-8608
Mailing Address - Fax:904-641-8608
Practice Address - Street 1:3311 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3704
Practice Address - Country:US
Practice Address - Phone:904-396-1462
Practice Address - Fax:904-396-1462
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist