Provider Demographics
NPI:1215185681
Name:MCGAVIN, KAREN ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANNE
Last Name:MCGAVIN
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 1:137 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5063
Mailing Address - Country:US
Mailing Address - Phone:850-833-7500
Mailing Address - Fax:850-833-7439
Practice Address - Street 1:137 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5063
Practice Address - Country:US
Practice Address - Phone:850-833-7451
Practice Address - Fax:850-833-7439
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2139M104100000X
FLSW115411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009913300Medicaid
FLHR086ZMedicare PIN