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General NPI Number Information
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NPI Number | 1174864870
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Entity Type | Individual
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Provider Name | KIM-MY LY LAC MSW
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Gender | Female
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 11875 HIGH TECH AVE SUITE 200
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City | ORLANDO
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State | FL
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Zip | 32817-1400
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Country | US
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Telephone | 407-273-2485
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Fax |
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Provider Business Mailing Address
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Address Line | 8103 CRUSHED PEPPER AVE
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City | ORLANDO
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State | FL
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Zip | 32817-2319
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Country | US
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Telephone | 352-359-6137
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW7767
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License Number State | FL
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