Provider Demographics
NPI:1982025300
Name:MCLAUGHLIN, CARLISE CHERILYN (LCSW, CAP)
Entity Type:Individual
Prefix:MS
First Name:CARLISE
Middle Name:CHERILYN
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:MS
Other - First Name:CARLISE
Other - Middle Name:CHERILYN
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CAP
Mailing Address - Street 1:151 MARY ESTHER BLVD
Mailing Address - Street 2:SUITE 310A
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1972
Mailing Address - Country:US
Mailing Address - Phone:850-226-6430
Mailing Address - Fax:850-254-1986
Practice Address - Street 1:151 MARY ESTHER BLVD
Practice Address - Street 2:SUITE 310A
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1972
Practice Address - Country:US
Practice Address - Phone:850-226-6430
Practice Address - Fax:850-254-1986
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 117341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHR125ZOtherMEDICARE ID/PTAN