Healthcare Provider Details

I. General information

NPI: 1861500647
Provider Name (Legal Business Name): LARENDA ANN DULEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 AURORA RD
MELBOURNE FL
32935-5384
US

IV. Provider business mailing address

5440 WILLOUGHBY DR
MELBOURNE FL
32934-2819
US

V. Phone/Fax

Practice location:
  • Phone: 321-242-3110
  • Fax: 321-242-7464
Mailing address:
  • Phone: 321-720-1513
  • Fax: 321-253-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7217
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW3134
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: