Provider Demographics
NPI:1043391956
Name:LOGALBO, JANET L (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:LOGALBO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SUNSET DR APT 901
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5553
Mailing Address - Country:US
Mailing Address - Phone:941-378-1549
Mailing Address - Fax:941-342-1781
Practice Address - Street 1:4041 BAHIA VISTA ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2421
Practice Address - Country:US
Practice Address - Phone:941-378-1549
Practice Address - Fax:941-342-1781
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW06781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8874OtherBCBS
FL479299OtherAETNA
FLK6784Medicare ID - Type UnspecifiedMEDICARE PRACTICE GROUP#
FLZ8874YMedicare ID - Type UnspecifiedMEDICARE
FLZ8874OtherBCBS