Provider Demographics
NPI:1932414141
Name:KRALJEV, LAURA FOSTER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:FOSTER
Last Name:KRALJEV
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 1:4721 RIVERGLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PONCE INLET
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7133
Mailing Address - Country:US
Mailing Address - Phone:386-846-6331
Mailing Address - Fax:
Practice Address - Street 1:4721 RIVERGLEN BLVD
Practice Address - Street 2:
Practice Address - City:PONCE INLET
Practice Address - State:FL
Practice Address - Zip Code:32127-7133
Practice Address - Country:US
Practice Address - Phone:386-846-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW94031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical