Provider Demographics
NPI:1043517147
Name:MOHEKY, LAURA LYNN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:MOHEKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5308
Mailing Address - Country:US
Mailing Address - Phone:321-449-4042
Mailing Address - Fax:
Practice Address - Street 1:620 SUNSET LN
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-5308
Practice Address - Country:US
Practice Address - Phone:321-449-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL677891701Medicaid
FL677891796Medicaid
FL677891768Medicaid