Provider Demographics
NPI:1255408837
Name:CANAVARROS, LENORE FELICE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LENORE
Middle Name:FELICE
Last Name:CANAVARROS
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:PO BOX 9478
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-9478
Mailing Address - Country:US
Mailing Address - Phone:941-782-4299
Mailing Address - Fax:
Practice Address - Street 1:2020 26TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7753
Practice Address - Country:US
Practice Address - Phone:941-782-4600
Practice Address - Fax:941-782-4601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW125241041C0700X
NYP063343-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN18N91Medicare ID - Type UnspecifiedPROVIDER I.D. #