Provider Demographics
NPI:1609240829
Name:LARA, ELIZABETH (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5385 ROBERTS CT
Mailing Address - Street 2:
Mailing Address - City:TARAWA TERRACE
Mailing Address - State:NC
Mailing Address - Zip Code:28543-1283
Mailing Address - Country:US
Mailing Address - Phone:386-216-7610
Mailing Address - Fax:
Practice Address - Street 1:2301 ALTON RD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-4008
Practice Address - Country:US
Practice Address - Phone:386-216-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-26
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0099131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical