Healthcare Provider Details

I. General information

NPI: 1386969970
Provider Name (Legal Business Name): LAURA LANE TABONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 WHIPPOORWILL LN
NAPLES FL
34105-3847
US

IV. Provider business mailing address

1095 WHIPPOORWILL LN
NAPLES FL
34105-3847
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-4404
  • Fax: 239-262-2429
Mailing address:
  • Phone: 239-261-4404
  • Fax: 239-262-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9456
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00155000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: