Healthcare Provider Details

I. General information

NPI: 1396045837
Provider Name (Legal Business Name): BRUCE LAFLEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25166 MARION AVE STE 112
PUNTA GORDA FL
33950-4017
US

IV. Provider business mailing address

25166 MARION AVE SUITE 112
PUNTA GORDA FL
33950-4017
US

V. Phone/Fax

Practice location:
  • Phone: 941-467-6347
  • Fax:
Mailing address:
  • Phone: 941-467-6247
  • Fax: 941-637-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: