Provider Demographics
NPI:1730487919
Name:METCALF, KHADEAN ALLICIA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KHADEAN
Middle Name:ALLICIA
Last Name:METCALF
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KHADEAN
Other - Middle Name:ALLICIA
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7305 N MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-7417
Mailing Address - Country:US
Mailing Address - Phone:561-422-7503
Mailing Address - Fax:561-422-1362
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-7503
Practice Address - Fax:561-422-1362
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker