Provider Demographics
NPI:1336441401
Name:KING, MINERVA MELODY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MINERVA
Middle Name:MELODY
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MINNIE
Other - Middle Name:MELODY
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1870 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-8901
Mailing Address - Country:US
Mailing Address - Phone:561-904-6514
Mailing Address - Fax:561-776-4213
Practice Address - Street 1:1870 FOREST HILL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8901
Practice Address - Country:US
Practice Address - Phone:561-904-6514
Practice Address - Fax:561-776-4213
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW112241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003275100Medicaid