Doctor Name: | CAROLYN N KETCHEL |
NPI Number: | 1972872216 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | SW4709 |
Business Practice Address: | 151 Mary Esther Blvd Suite 302 Mary Esther, FL - 325691972 |
Business Phone Number: | 8502431302 |
Business Fax Number: | 8503010671 |
Mailing Address: | Po Box 7, SHALIMAR |
State: | FL |
Postal Code: | 325790007 |
Phone Number: | 8502431302 |
Fax Number: | 8503010671 |
NPI Enumeration Date: | 12/15/2011 |
NPI Last Update Date: | 02/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | SW4709 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |