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General NPI Number Information
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NPI Number | 1386134039
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Entity Type | Individual
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Provider Name | MARY LOFTUS MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 725 N 12TH AVE BLDG B
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City | ARCADIA
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State | FL
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Zip | 34266-8752
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Country | US
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Telephone | 863-494-1242
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Fax | 863-491-0466
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Provider Business Mailing Address
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Address Line | 5400 S WILLIAMSON BLVD APT 2-301
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City | PORT ORANGE
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State | FL
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Zip | 32128-6531
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Country | US
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Telephone | 504-913-4472
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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 | SW12819
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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