Healthcare Provider Details

I. General information

NPI: 1275806358
Provider Name (Legal Business Name): LAURIE PATRICIA KEEFE-CECERE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8163 S FLORIDA AVE
FLORAL CITY FL
34436-3101
US

IV. Provider business mailing address

PO BOX 121
FLORAL CITY FL
34436-0121
US

V. Phone/Fax

Practice location:
  • Phone: 352-400-9118
  • Fax:
Mailing address:
  • Phone: 352-400-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: