Healthcare Provider Details

I. General information

NPI: 1639592090
Provider Name (Legal Business Name): HAMPRENATE SERVICE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 HEALTHPARK CIR
FORT MYERS FL
33908-3600
US

IV. Provider business mailing address

9470 HEALTHPARK CIR
FORT MYERS FL
33908-3600
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-4673
  • Fax:
Mailing address:
  • Phone: 239-482-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: