Basic Information
| Provider Information | |||||||||
| NPI: | 1285769570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUBERT | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4131 NW 28TH LN STE 6 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326067432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523753001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4131 NW 28TH LN STE 6 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326067432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523753001 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 12/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW1750 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.