Healthcare Provider Details

I. General information

NPI: 1801418348
Provider Name (Legal Business Name): KATHRYN SCRIVENER, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SHAMROCK ST S STE 103
TALLAHASSEE FL
32309-3349
US

IV. Provider business mailing address

3201 SHAMROCK ST S STE 103
TALLAHASSEE FL
32309-3349
US

V. Phone/Fax

Practice location:
  • Phone: 850-566-0648
  • Fax:
Mailing address:
  • Phone: 850-566-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN SCRIVENER
Title or Position: OWNER
Credential: LCSW
Phone: 850-566-0648