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NPI Code Detail

MEDICARE: MRS. LAURA JANE BEVILL LCSW

MEDICARE: MRS. LAURA JANE BEVILL LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSW4040FL

General Provider Information

NPI Number : 1265050470
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA JANE BEVILL LCSW
Provider Business Mailing Address
First Line : 10947 NW 56TH CT
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33076-3112
Country : US
Telephone Number : 954-234-1028
Fax Number :
Provider Business Practice Location Address
First Line : 5571 N UNIVERSITY DR STE 101
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33067-4653
Country : US
Telephone Number : 434-956-4106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2020
Last Update Date : 07/14/2020

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