Provider Demographics
NPI:1679596019
Name:CHASE, LAURA C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:C
Last Name:CHASE
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 1:1051 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE HELEN
Mailing Address - State:FL
Mailing Address - Zip Code:32744-3321
Mailing Address - Country:US
Mailing Address - Phone:571-337-4997
Mailing Address - Fax:
Practice Address - Street 1:647 S WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5810
Practice Address - Country:US
Practice Address - Phone:571-337-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040050471041C0700X
FLSW110711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008948267Medicaid
VA9262550OtherPHCS
TX3541446OtherAETNA HEALTH MGMT
MD727392000OtherMAGELLAN INS.
IL250040OtherCOMPSYCH CORP.
VA349561OtherMHN INS.
VA175575OtherANTHEM INS.
MD727392000OtherMAGELLAN INS.