MEDICARE: KATHRYN WHITE 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	SW25288	FL

General Provider Information

NPI Number	:	1063383032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN WHITE LCSW

Provider Business Mailing Address
First Line	:	3443 ACAPULCO CIR
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-5380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 TAMIAMI TRL STE 500
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-1083
Country	:	US
Telephone Number	:	941-780-4268
Fax Number	:

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

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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