Provider Demographics
NPI:1437380540
Name:DEPOOLE, ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:DEPOOLE
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 1:1001 STARKEY RD
Mailing Address - Street 2:#67
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-5495
Mailing Address - Country:US
Mailing Address - Phone:727-365-5468
Mailing Address - Fax:727-533-8141
Practice Address - Street 1:13191 STARKEY RD STE 14
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1400
Practice Address - Country:US
Practice Address - Phone:727-446-8559
Practice Address - Fax:727-533-8141
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMSWMedicaid