Provider Demographics
NPI:1659079408
Name:BERNY, GEORGIA (LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:BERNY
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 1:11800 N FLORIDA AVE # 82214
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5212
Mailing Address - Country:US
Mailing Address - Phone:813-252-0938
Mailing Address - Fax:
Practice Address - Street 1:901 E KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3502
Practice Address - Country:US
Practice Address - Phone:813-252-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW210001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical