Healthcare Provider Details

I. General information

NPI: 1134529605
Provider Name (Legal Business Name): LOURDES CONTRERAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 MAPLE AVE
FORT PIERCE FL
34982-5949
US

IV. Provider business mailing address

761 SW JASLO AVE
PORT SAINT LUCIE FL
34953-3940
US

V. Phone/Fax

Practice location:
  • Phone: 772-245-0048
  • Fax:
Mailing address:
  • Phone: 646-314-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW19224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: