Provider Demographics
NPI:1760646178
Name:BEARD, ALISHA CORNELL BRILL (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:CORNELL BRILL
Last Name:BEARD
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 1:10810 BOYETTE UNIT 1032
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33568-7043
Mailing Address - Country:US
Mailing Address - Phone:813-748-5141
Mailing Address - Fax:
Practice Address - Street 1:522 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5743
Practice Address - Country:US
Practice Address - Phone:813-748-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSSW114341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical