Healthcare Provider Details

I. General information

NPI: 1275229171
Provider Name (Legal Business Name): LAUREN WHITWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 6TH AVE W
BRADENTON FL
34205-8820
US

IV. Provider business mailing address

5621 1ST AVE E APT 304
BRADENTON FL
34208-6006
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: