Provider Demographics
NPI:1629146675
Name:LERSCH, SYLVIA C (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:C
Last Name:LERSCH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 SPOONBILL DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7601
Mailing Address - Country:US
Mailing Address - Phone:941-505-9144
Mailing Address - Fax:941-624-5613
Practice Address - Street 1:1435 COLLINGSWOOD BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948
Practice Address - Country:US
Practice Address - Phone:941-766-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW 46081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8482Medicare ID - Type Unspecified