Healthcare Provider Details

I. General information

NPI: 1174453302
Provider Name (Legal Business Name): MASSIEL LARA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11379 PORTOLA LN
SPRING HILL FL
34609-3753
US

IV. Provider business mailing address

11379 PORTOLA LN
SPRING HILL FL
34609-3753
US

V. Phone/Fax

Practice location:
  • Phone: 917-600-0298
  • Fax: 917-600-0298
Mailing address:
  • Phone: 917-600-0298
  • Fax: 917-600-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: