Provider Demographics
NPI:1063042067
Name:SWEET, TAYLOR LAUREN
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LAUREN
Last Name:SWEET
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 1:477 HIDDEN MEADOWS LOOP APT 103
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2515
Mailing Address - Country:US
Mailing Address - Phone:863-662-7431
Mailing Address - Fax:
Practice Address - Street 1:628 E PINE ST STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-6605
Practice Address - Country:US
Practice Address - Phone:407-967-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health