Healthcare Provider Details

I. General information

NPI: 1427072636
Provider Name (Legal Business Name): KATHLEEN J. HULBERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD 116A-2
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

PO BOX 902
NEWBERRY FL
32669-0902
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-376-7901
Mailing address:
  • Phone: 352-472-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4819
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: