Provider Demographics
NPI:1902407299
Name:SWEETING, BEVERLY DIANE (LPN, CLC, MSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DIANE
Last Name:SWEETING
Suffix:
Gender:F
Credentials:LPN, CLC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10961 SW IVORY SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-7710
Mailing Address - Country:US
Mailing Address - Phone:786-512-3680
Mailing Address - Fax:
Practice Address - Street 1:10961 SW IVORY SPRINGS LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-7710
Practice Address - Country:US
Practice Address - Phone:786-512-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN441421164W00000X
FLISW95711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No164W00000XNursing Service ProvidersLicensed Practical Nurse