Provider Demographics
NPI:1124077896
Name:MUCCIARDI, BEVERLEY N (LCSW)
Entity type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:N
Last Name:MUCCIARDI
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 1:10100 W SAMPLE RD
Mailing Address - Street 2:SUITE 332
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3973
Mailing Address - Country:US
Mailing Address - Phone:954-825-0020
Mailing Address - Fax:
Practice Address - Street 1:10100 W SAMPLE RD
Practice Address - Street 2:SUITE 332
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3973
Practice Address - Country:US
Practice Address - Phone:954-825-0020
Practice Address - Fax:954-825-0044
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW52181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9557Medicare ID - Type Unspecified