Provider Demographics
NPI:1437805132
Name:MOORE, LAURA CAROLYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CAROLYN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:CAROLYN
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2610 CABOT RD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5010
Mailing Address - Country:US
Mailing Address - Phone:813-240-9589
Mailing Address - Fax:
Practice Address - Street 1:2610 CABOT RD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5010
Practice Address - Country:US
Practice Address - Phone:813-240-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW80071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical