=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881025914
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAVERNE MARIE KALAFOR LCSW, EDS, CCHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2013
-----------------------------------------------------
Last Update Date | 10/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7018 US HIGHWAY 301 N
-----------------------------------------------------
City | ELLENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34222-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-720-5732
-----------------------------------------------------
Fax | 914-417-2371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7018 US HIGHWAY 301 N
-----------------------------------------------------
City | ELLENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34222-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-720-5732
-----------------------------------------------------
Fax | 914-417-2371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 11640
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW11640
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------