Provider Demographics
NPI:1336791813
Name:PLAYER, LORETTA ANN
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:ANN
Last Name:PLAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:ANN
Other - Last Name:BARANOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 1/2 N WOODLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-4268
Mailing Address - Country:US
Mailing Address - Phone:321-866-8976
Mailing Address - Fax:
Practice Address - Street 1:118 N WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4217
Practice Address - Country:US
Practice Address - Phone:321-866-8976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19686101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor