MEDICARE: MS. KATHRYN FLORENCE PRIEST 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	SW14768	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770127938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN FLORENCE PRIEST LCSW

Provider Business Mailing Address
First Line	:	145 NW CENTRAL PARK PLZ STE 102
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2482
Country	:	US
Telephone Number	:	772-218-5056
Fax Number	:	561-210-3253

Provider Business Practice Location Address
First Line	:	11987 SW CRESTWOOD CIR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-2739
Country	:	US
Telephone Number	:	772-577-8846
Fax Number	:

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

Provider Enumeration Date	:	10/31/2019
Last Update Date	:	01/30/2020

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