Provider Demographics
NPI:1306924600
Name:BEVERLEY N MUCCIARDI LCSW PA
Entity type:Organization
Organization Name:BEVERLEY N MUCCIARDI LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESISDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:NITSCH
Authorized Official - Last Name:MUCCIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-825-0020
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:954-825-0044
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 52181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty