Provider Demographics
NPI:1902660681
Name:SOUVERAIN, ELBYDIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELBYDIA
Middle Name:
Last Name:SOUVERAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELBYDIA
Other - Middle Name:
Other - Last Name:SOUVERIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11055 SW 186TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6842
Mailing Address - Country:US
Mailing Address - Phone:786-692-5743
Mailing Address - Fax:786-422-9043
Practice Address - Street 1:11055 SW 186TH ST STE 207
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6842
Practice Address - Country:US
Practice Address - Phone:786-692-5743
Practice Address - Fax:786-422-9043
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW211061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW21106OtherLICENSE