Provider Demographics
NPI:1164505350
Name:HEALY, LAUREL SMITH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:SMITH
Last Name:HEALY
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 1:2060 MISTY SUNRISE TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9685
Mailing Address - Country:US
Mailing Address - Phone:941-378-3103
Mailing Address - Fax:941-378-3103
Practice Address - Street 1:2060 MISTY SUNRISE TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9685
Practice Address - Country:US
Practice Address - Phone:941-378-3103
Practice Address - Fax:941-378-3100
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3861Medicare ID - Type Unspecified