Healthcare Provider Details

I. General information

NPI: 1619731312
Provider Name (Legal Business Name): LORI LANDES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5458 TOWN CENTER RD STE 7
BOCA RATON FL
33486-1026
US

IV. Provider business mailing address

8130 GLADES RD # 503
BOCA RATON FL
33434-4064
US

V. Phone/Fax

Practice location:
  • Phone: 772-405-7255
  • Fax:
Mailing address:
  • Phone: 772-405-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09932863
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22368
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14185227-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: