Provider Demographics
NPI:1396045837
Name:LAFLEN, BRUCE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:LAFLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25166 MARION AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4017
Mailing Address - Country:US
Mailing Address - Phone:941-467-6247
Mailing Address - Fax:941-637-2530
Practice Address - Street 1:25166 MARION AVE
Practice Address - Street 2:STE 112
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4017
Practice Address - Country:US
Practice Address - Phone:941-467-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEE418ZMedicare PIN