Healthcare Provider Details

I. General information

NPI: 1447747571
Provider Name (Legal Business Name): SARAH GRACE SOLORZANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 CURRENCY CIR
LAKE MARY FL
32746-2115
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 407-804-6133
  • Fax: 866-447-9143
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14026
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: