Provider Demographics
NPI:1861500647
Name:DULEY, LARENDA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LARENDA
Middle Name:ANN
Last Name:DULEY
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 1:5440 WILLOUGHBY DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-2819
Mailing Address - Country:US
Mailing Address - Phone:321-720-1513
Mailing Address - Fax:321-253-8378
Practice Address - Street 1:1425 AURORA RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5384
Practice Address - Country:US
Practice Address - Phone:321-242-3110
Practice Address - Fax:321-242-7464
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW72171041C0700X
HILCSW31341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical