MEDICARE: MRS. ANGELA LA'SHEA TROTTER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW17853	FL

General Provider Information

NPI Number	:	1174304067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA LA'SHEA TROTTER LCSW

Provider Business Mailing Address
First Line	:	3771 38TH WAY S APT A
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33711-4146
Country	:	US
Telephone Number	:	270-366-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	3771 38TH WAY S APT A
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33711-4146
Country	:	US
Telephone Number	:	270-366-1434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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