MEDICARE: MASSIEL LARA 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	SW26500	FL

General Provider Information

NPI Number	:	1174453302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASSIEL LARA LCSW

Provider Business Mailing Address
First Line	:	11379 PORTOLA LN
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-3753
Country	:	US
Telephone Number	:	917-600-0298
Fax Number	:	917-600-0298

Provider Business Practice Location Address
First Line	:	11379 PORTOLA LN
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-3753
Country	:	US
Telephone Number	:	917-600-0298
Fax Number	:	917-600-0298

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

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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Directions to “ MASSIEL LARA LCSW” Practice Location

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