Healthcare Provider Details

I. General information

NPI: 1417863135
Provider Name (Legal Business Name): LORA AVILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 VENETIA BAY BLVD STE 360
VENICE FL
34285-8051
US

IV. Provider business mailing address

8941 ARTISAN WAY
SARASOTA FL
34240-2501
US

V. Phone/Fax

Practice location:
  • Phone: 941-485-8586
  • Fax:
Mailing address:
  • Phone: 941-724-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: