Provider Demographics
NPI:1033880869
Name:NETHERY, KATRINA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANN
Last Name:NETHERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2222
Mailing Address - Country:US
Mailing Address - Phone:941-447-3757
Mailing Address - Fax:
Practice Address - Street 1:7821 N DALE MABRY HWY STE 214
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3200
Practice Address - Country:US
Practice Address - Phone:813-443-4827
Practice Address - Fax:813-443-4828
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW189411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty