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NPI Code Detail

MEDICARE: ALEXIS DESARAE LAPORTA LCSW

MEDICARE: ALEXIS DESARAE LAPORTA 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1245896588
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS DESARAE LAPORTA LCSW
Provider Business Mailing Address
First Line : PO BOX 764
Second Line :
City : LAKE VILLA
State : IL
Zip : 60046-0764
Country : US
Telephone Number : 847-377-8296
Fax Number : 847-984-5689
Provider Business Practice Location Address
First Line : 89 CEDAR AVE
Second Line :
City : LAKE VILLA
State : IL
Zip : 60046-8411
Country : US
Telephone Number : 847-265-7300
Fax Number : 847-265-7300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2019
Last Update Date : 01/27/2026

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