Provider Demographics
NPI:1770127938
Name:PRIEST, KATHRYN FLORENCE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:FLORENCE
Last Name:PRIEST
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 1:145 NW CENTRAL PARK PLZ STE 102
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2482
Mailing Address - Country:US
Mailing Address - Phone:772-218-5056
Mailing Address - Fax:561-210-3253
Practice Address - Street 1:11987 SW CRESTWOOD CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2739
Practice Address - Country:US
Practice Address - Phone:772-577-8846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW147681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW14768Medicaid