MEDICARE: MRS. LAURA CHRISTINE PERCY LMSW

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	007057	SC

General Provider Information

NPI Number	:	1700139292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA CHRISTINE PERCY LMSW

Provider Business Mailing Address
First Line	:	1210 W 1ST ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7206
Country	:	US
Telephone Number	:	772-882-4857
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 W 1ST ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7206
Country	:	US
Telephone Number	:	772-882-4857
Fax Number	:

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

Provider Enumeration Date	:	10/21/2012
Last Update Date	:	10/21/2012

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