Provider Demographics
NPI:1831319193
Name:PURVIS, LAURIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:PURVIS
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 1:1825 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-8902
Mailing Address - Country:US
Mailing Address - Phone:561-649-9095
Mailing Address - Fax:561-964-8918
Practice Address - Street 1:1825 FOREST HILL BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8902
Practice Address - Country:US
Practice Address - Phone:561-649-9095
Practice Address - Fax:561-964-8918
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00005161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2749Medicare ID - Type UnspecifiedMEDICARE