Provider Demographics
NPI:1689914657
Name:BEVERLY, KATHRYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:BEVERLY
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 1:201 S 2ND ST STE 100
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4326
Mailing Address - Country:US
Mailing Address - Phone:772-672-4715
Mailing Address - Fax:772-448-4195
Practice Address - Street 1:201 S 2ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4326
Practice Address - Country:US
Practice Address - Phone:772-672-4715
Practice Address - Fax:772-448-4195
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW109021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical