Provider Demographics
NPI:1023410396
Name:SLB, L.L.C.
Entity type:Organization
Organization Name:SLB, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-682-3251
Mailing Address - Street 1:5020 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2807
Mailing Address - Country:US
Mailing Address - Phone:239-682-3251
Mailing Address - Fax:
Practice Address - Street 1:5020 TAMIAMI TRL N
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2807
Practice Address - Country:US
Practice Address - Phone:239-682-3251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW121891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHZ217AOtherMEDICARE PTAN
OHH420860OtherMEDICARE PTAN