Healthcare Provider Details

I. General information

NPI: 1053539098
Provider Name (Legal Business Name): LAUREN WOODRUFF ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 STATE ST
SARASOTA FL
34236-5808
US

IV. Provider business mailing address

1565 STATE ST
SARASOTA FL
34236-5808
US

V. Phone/Fax

Practice location:
  • Phone: 941-927-8900
  • Fax: 941-954-8631
Mailing address:
  • Phone: 941-927-8900
  • Fax: 866-201-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: