=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437380540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN DEPOOLE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2009
-----------------------------------------------------
Last Update Date | 09/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13191 STARKEY RD STE 14
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33773-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-446-8559
-----------------------------------------------------
Fax | 727-533-8141
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 STARKEY RD #67
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33771-5495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-365-5468
-----------------------------------------------------
Fax | 727-533-8141
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | MSW
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------