Provider Demographics
NPI:1013132042
Name:FARLEY, LAURA E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:E
Last Name:FARLEY
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 1:11501 NW 2ND AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33168-4443
Mailing Address - Country:US
Mailing Address - Phone:305-758-0067
Mailing Address - Fax:
Practice Address - Street 1:11501 NW 2ND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33168-4443
Practice Address - Country:US
Practice Address - Phone:305-758-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW49621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1188Medicare ID - Type Unspecified