Provider Demographics
NPI:1649369646
Name:LOGAN, MARGOT ELLEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARGOT
Middle Name:ELLEN
Last Name:LOGAN
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 1195
Mailing Address - Street 2:
Mailing Address - City:GOLDENROD
Mailing Address - State:FL
Mailing Address - Zip Code:32733-1195
Mailing Address - Country:US
Mailing Address - Phone:407-977-4449
Mailing Address - Fax:407-977-8639
Practice Address - Street 1:1155 S SEMORAN BLVD STE 1150
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5505
Practice Address - Country:US
Practice Address - Phone:407-738-6059
Practice Address - Fax:407-374-1771
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MALICSW1283081041C0700X
FLSW72591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical