Provider Demographics
NPI:1003499310
Name:BRASWELL, LAURA (MDIV LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:MDIV LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 HOLLINGSWORTH HILL AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3238
Mailing Address - Country:US
Mailing Address - Phone:863-660-5243
Mailing Address - Fax:
Practice Address - Street 1:2625 HOLLINGSWORTH HILL AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3238
Practice Address - Country:US
Practice Address - Phone:863-660-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW69601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical