Provider Demographics
NPI:1376181594
Name:STANKO, LEE (MSW)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:STANKO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 BLACK OAK CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-4357
Mailing Address - Country:US
Mailing Address - Phone:941-623-3818
Mailing Address - Fax:
Practice Address - Street 1:1700 PARK ST N STE 109
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4300
Practice Address - Country:US
Practice Address - Phone:941-623-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW11122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker