Provider Demographics
NPI:1356444962
Name:THORNTON, LOUISE OAST (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:OAST
Last Name:THORNTON
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 1:305 1/2 W VENICE AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2051
Mailing Address - Country:US
Mailing Address - Phone:757-390-0213
Mailing Address - Fax:757-425-1389
Practice Address - Street 1:4310 METRO PKWY STE 205
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9416
Practice Address - Country:US
Practice Address - Phone:239-223-2751
Practice Address - Fax:239-561-2933
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW156961041C0700X
VA09040019351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010023351Medicaid
VA010023351Medicaid
VA005027P99Medicare ID - Type Unspecified