MEDICARE: LAKEYATTA HAYWARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		FL
2	1041C0700X	Clinical Social Worker		FL
3	376J00000X	Homemaker	235989	FL

General Provider Information

NPI Number	:	1528623410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKEYATTA HAYWARD

Provider Business Mailing Address
First Line	:	PO BOX 60446
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33906-6446
Country	:	US
Telephone Number	:	239-202-3547
Fax Number	:	239-734-2047

Provider Business Practice Location Address
First Line	:	12557 NEW BRITTANY BLVD STE 3V-4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3651
Country	:	US
Telephone Number	:	239-202-3547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	06/23/2022

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Directions to “ LAKEYATTA HAYWARD ” Practice Location

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