MEDICARE: MRS. KATIE STAFFORD 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
1	1041C0700X	Clinical Social Worker	SW17478	FL

General Provider Information

NPI Number	:	1790277853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATIE STAFFORD LCSW

Provider Business Mailing Address
First Line	:	13837 54TH LN N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-8347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2054 VISTA PKWY
Second Line	:	SUITE 400
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411
Country	:	US
Telephone Number	:	561-389-1161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	03/18/2026

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