MEDICARE: ALYSSA NICOLE LABAT 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	SW23620	FL

General Provider Information

NPI Number	:	1619798873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA NICOLE LABAT LCSW

Provider Business Mailing Address
First Line	:	13525 BARTRAM PARK BLVD UNIT 632
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5253
Country	:	US
Telephone Number	:	904-487-9265
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 CLAIRE LN STE 202
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-6665
Country	:	US
Telephone Number	:	904-479-5963
Fax Number	:

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

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/21/2024

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