Provider Demographics
NPI:1821712712
Name:CECILIA LAND LCSW-R
Entity Type:Organization
Organization Name:CECILIA LAND LCSW-R
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:MICHELLE PAPALAS
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-866-0423
Mailing Address - Street 1:15 RENEE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3748
Mailing Address - Country:US
Mailing Address - Phone:347-866-0423
Mailing Address - Fax:
Practice Address - Street 1:640 BREVARD AVE
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7849
Practice Address - Country:US
Practice Address - Phone:347-866-0423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861664294OtherNPI