Provider Demographics
NPI:1477763522
Name:YEARDLEY, MARY CAROLINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CAROLINE
Last Name:YEARDLEY
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 1:7420 SW 172ND ST
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4830
Mailing Address - Country:US
Mailing Address - Phone:305-255-3352
Mailing Address - Fax:
Practice Address - Street 1:1390 S DIXIE HWY STE 2109
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2944
Practice Address - Country:US
Practice Address - Phone:305-663-4433
Practice Address - Fax:305-663-9944
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0016261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical