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General NPI Number Information
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NPI Number | 1689528846
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Entity Type | Organization
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Legal Business Name | DR. LAKE AND ASSOCIATES
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 130 E BLOOMINGDALE AVE
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City | BRANDON
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State | FL
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Zip | 33511-8101
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Country | US
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Telephone | 813-444-8760
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Fax |
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Provider Business Mailing Address
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Address Line | 10863 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-8012
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Country | US
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Telephone | 813-444-8760
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Fax | 813-437-1432
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Authorized Official
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Title or Position | SOCIAL WORKER THERAPIST
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Name | MARIAH NAVAS
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Credential |
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Telephone | 828-744-9596
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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 |
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License Number State |
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