Provider Demographics
NPI:1750486536
Name:MCCLOUD-BEVLY, VIOLA (CSW)
Entity Type:Individual
Prefix:MRS
First Name:VIOLA
Middle Name:
Last Name:MCCLOUD-BEVLY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 GREEN VALLEY CIR UNIT 219
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-8102
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4112
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:BLDG 256,
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW00000064261041C0700X
CAASW118221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCSW0000006426OtherCERTIFIED MASTER OF SW
CAASW11822OtherASSOCIATE CLINICAL SW