Provider Demographics
NPI:1275931578
Name:VEEDON, LIBERTY DAVIS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LIBERTY
Middle Name:DAVIS
Last Name:VEEDON
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 1:2801 FRUITVILLE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5336
Mailing Address - Country:US
Mailing Address - Phone:941-313-5333
Mailing Address - Fax:
Practice Address - Street 1:2801 FRUITVILLE RD STE 110
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5336
Practice Address - Country:US
Practice Address - Phone:941-313-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW12241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health