Provider Demographics
NPI:1568740785
Name:CHICONE, LARA PENNEY
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:PENNEY
Last Name:CHICONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-6411
Mailing Address - Country:US
Mailing Address - Phone:321-452-0800
Mailing Address - Fax:
Practice Address - Street 1:1407 DIXON BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-6411
Practice Address - Country:US
Practice Address - Phone:321-452-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator