Healthcare Provider Details

I. General information

NPI: 1770132946
Provider Name (Legal Business Name): CATHERINE ASHELEY EMMETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 TAMIAMI TRL STE 500
PORT CHARLOTTE FL
33948-1083
US

IV. Provider business mailing address

1777 TAMIAMI TRL STE 500
PORT CHARLOTTE FL
33948-1083
US

V. Phone/Fax

Practice location:
  • Phone: 941-780-4268
  • Fax: 941-979-9377
Mailing address:
  • Phone: 941-780-4268
  • Fax: 941-979-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: