MEDICARE: MS. LAUREN GWENETTE CLIFFEL 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	SW10856	FL

General Provider Information

NPI Number	:	1568719375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN GWENETTE CLIFFEL LCSW

Provider Business Mailing Address
First Line	:	20118 INDIAN ROSEWOOD DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3483
Country	:	US
Telephone Number	:	813-468-8751
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 S DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33621-5129
Country	:	US
Telephone Number	:	813-828-1110
Fax Number	:

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

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	08/10/2012

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