Healthcare Provider Details

I. General information

NPI: 1992373682
Provider Name (Legal Business Name): RAVYN ALEXANDRIA ROONEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 LANDOVER BLVD
SPRING HILL FL
34608-7258
US

IV. Provider business mailing address

2985 LANDOVER BLVD
SPRING HILL FL
34608-7258
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-3630
  • Fax: 352-683-8892
Mailing address:
  • Phone: 352-683-3630
  • Fax: 352-683-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: