Basic Information
| Provider Information | |||||||||
| NPI: | 1962591909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | METCALFE | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5955 ZEAMER AVE | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995063702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075805858 | ||||||||
| FaxNumber: | 9075801776 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 GAFFNEY RD # 7440 | ||||||||
| Address2: | COMMANDER, USA-MEDDAC-AK, ATTN:MCUC-MMD-QM | ||||||||
| City: | FT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 492 | AK | Y | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 22192 | CA | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.