Provider Demographics
NPI:1104873306
Name:STEVENSON, GLORIA (RN, LCSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4356 FUSCHIA CIR S
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5431
Mailing Address - Country:US
Mailing Address - Phone:561-622-6420
Mailing Address - Fax:
Practice Address - Street 1:900 54TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2436
Practice Address - Country:US
Practice Address - Phone:561-842-2406
Practice Address - Fax:561-865-5379
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW29021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4582ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER