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NPI Code Detail

MEDICARE: ELIZABETH LAPRADE RBT, LCSW-A

MEDICARE: ELIZABETH LAPRADE RBT, LCSW-A
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
1106S00000XBehavior TechnicianNC
21041C0700XClinical Social WorkerP022683NC

General Provider Information

NPI Number : 1619522661
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH LAPRADE RBT, LCSW-A
Provider Business Mailing Address
First Line : 6438 BAUX MOUNTAIN RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27105-8718
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 905 FRIEDBERG CHURCH RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27127-9803
Country : US
Telephone Number : 336-251-1180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2019
Last Update Date : 11/17/2025

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