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NPI Code Detail

MEDICARE: MRS. LARA PENNEY CHICONE

MEDICARE: MRS. LARA PENNEY CHICONE
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
1104100000XSocial Worker
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1568740785
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LARA PENNEY CHICONE
Provider Business Mailing Address
First Line : 1407 DIXON BLVD
Second Line :
City : COCOA
State : FL
Zip : 32922-6411
Country : US
Telephone Number : 321-452-0800
Fax Number :
Provider Business Practice Location Address
First Line : 1407 DIXON BLVD
Second Line :
City : COCOA
State : FL
Zip : 32922-6411
Country : US
Telephone Number : 321-452-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2011
Last Update Date : 06/11/2013

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Directions to “ MRS. LARA PENNEY CHICONE ” Practice Location

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