Provider Demographics
NPI:1164470605
Name:POLITE-EAFORD, CHERYL DIANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DIANA
Last Name:POLITE-EAFORD
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 1:17550 NW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4708
Mailing Address - Country:US
Mailing Address - Phone:305-624-5901
Mailing Address - Fax:305-624-5901
Practice Address - Street 1:17550 NW 20TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4708
Practice Address - Country:US
Practice Address - Phone:305-624-5901
Practice Address - Fax:305-624-5901
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 79391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical