1750486536 NPI number — MRS. VIOLA MCCLOUD-BEVLY CSW

Table of content: MRS. VIOLA MCCLOUD-BEVLY CSW (NPI 1750486536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750486536 NPI number — MRS. VIOLA MCCLOUD-BEVLY CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLOUD-BEVLY
Provider First Name:
VIOLA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750486536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6605 GREEN VALLEY CIR UNIT 219
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULVER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90230-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-478-3711
Provider Business Mailing Address Fax Number:
310-268-4112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11301 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
BLDG 256,
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-478-3711
Provider Business Practice Location Address Fax Number:
310-268-4112
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW0000006426 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: ASW11822 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CSW0000006426 . This is a "CERTIFIED MASTER OF SW" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: ASW11822 . This is a "ASSOCIATE CLINICAL SW" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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