Provider Demographics
NPI:1831344027
Name:CONLEY, LARA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:
Last Name:CONLEY
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 1:805 E BROWARD BLVD STE 301G
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2046
Mailing Address - Country:US
Mailing Address - Phone:954-306-9526
Mailing Address - Fax:
Practice Address - Street 1:2755 E OAKLAND PARK BLVD STE 225
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1629
Practice Address - Country:US
Practice Address - Phone:954-306-9526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1257801041C0700X
ORL59871041C0700X
FLSW115201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical