Provider Demographics
NPI:1861664294
Name:LAND, CECILIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:
Last Name:LAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CECILIA
Other - Middle Name:
Other - Last Name:LAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAT
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 STE 106
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:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076373104100000X
NY730776221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker