Healthcare Provider Details

I. General information

NPI: 1942395850
Provider Name (Legal Business Name): MICHELE LINDA LANESE MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 W HILLSBORO BLVD SUITE B1
COCONUT CREEK FL
33073-4356
US

IV. Provider business mailing address

4855 W HILLSBORO BLVD SUITE B1
COCONUT CREEK FL
33073-4356
US

V. Phone/Fax

Practice location:
  • Phone: 954-345-5525
  • Fax: 954-977-4978
Mailing address:
  • Phone: 954-345-5525
  • Fax: 954-977-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0001662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: