Provider Demographics
NPI:1912683178
Name:DEBLASIO, LAUREN A (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:A
Last Name:DEBLASIO
Suffix:
Gender:F
Credentials:MSW, 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 542234
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33454-2234
Mailing Address - Country:US
Mailing Address - Phone:810-210-2738
Mailing Address - Fax:
Practice Address - Street 1:4651 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6107
Practice Address - Country:US
Practice Address - Phone:646-453-6777
Practice Address - Fax:212-337-9841
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW134591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical