Provider Demographics
NPI:1366955205
Name:BUELL, KATHY S (MSW)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:S
Last Name:BUELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1406
Mailing Address - Country:US
Mailing Address - Phone:727-459-6716
Mailing Address - Fax:
Practice Address - Street 1:6177 SUN BLVD APT 404
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-1146
Practice Address - Country:US
Practice Address - Phone:172-769-8254
Practice Address - Fax:727-698-2543
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW38761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical