Healthcare Provider Details

I. General information

NPI: 1891623021
Provider Name (Legal Business Name): TARA LASSI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 HOMEPLACE DR APT 1451
JACKSONVILLE FL
32256-1934
US

IV. Provider business mailing address

2033 HIGH VISTA DR
LAKELAND FL
33813-3074
US

V. Phone/Fax

Practice location:
  • Phone: 863-944-9959
  • Fax:
Mailing address:
  • Phone: 863-944-9959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: