Provider Demographics
NPI:1760511851
Name:DREVICH, NANCY J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:DREVICH
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 1:6022 PLAINS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-1507
Mailing Address - Country:US
Mailing Address - Phone:561-499-6716
Mailing Address - Fax:
Practice Address - Street 1:16244 MILITARY TRL
Practice Address - Street 2:325
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:561-499-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00017881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW0001788OtherSTATE LICENSE
FL40109Medicare ID - Type UnspecifiedGROUP NUMBER
FLZ5070YMedicare ID - Type UnspecifiedINDIVIDUAL