Provider Demographics
NPI:1801418348
Name:KATHRYN SCRIVENER, LCSW LLC
Entity Type:Organization
Organization Name:KATHRYN SCRIVENER, LCSW LLC
Other - Org Name:KATHRYN SCRIVENER, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIVENER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-566-0648
Mailing Address - Street 1:3201 SHAMROCK ST S STE 103
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3349
Mailing Address - Country:US
Mailing Address - Phone:850-566-0648
Mailing Address - Fax:
Practice Address - Street 1:3201 SHAMROCK ST S STE 103
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3349
Practice Address - Country:US
Practice Address - Phone:850-566-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty