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General NPI Number Information
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NPI Number | 1306924600
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Entity Type | Organization
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Legal Business Name | BEVERLEY N MUCCIARDI LCSW PA
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10100 W SAMPLE RD SUITE 332
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3973
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Country | US
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Telephone | 954-825-0020
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Fax | 954-825-0044
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Provider Business Mailing Address
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Address Line | 10100 W SAMPLE RD SUITE 332
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3973
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Country | US
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Telephone | 954-825-0020
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Fax | 954-825-0044
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Authorized Official
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Title or Position | PRESISDENT
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Name | MS. BEVERLEY NITSCH MUCCIARDI
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Credential | LCSW
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Telephone | 954-825-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 5218
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License Number State | FL
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