Provider Demographics
NPI:1366503765
Name:FLORES, ILEANA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ILEANA
Middle Name:
Last Name:FLORES
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 1:3042 POINTER DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2452
Mailing Address - Country:US
Mailing Address - Phone:727-871-1050
Mailing Address - Fax:
Practice Address - Street 1:3042 POINTER DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2452
Practice Address - Country:US
Practice Address - Phone:727-871-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW55721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical