Provider Demographics
NPI:1154718781
Name:LE, ANA R
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:R
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:R
Other - Last Name:GARIBAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MSW
Mailing Address - Street 1:6000 S FLORIDA AVE # 5323
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3320
Mailing Address - Country:US
Mailing Address - Phone:415-259-1031
Mailing Address - Fax:
Practice Address - Street 1:6000 S FLORIDA AVE # 5323
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3320
Practice Address - Country:US
Practice Address - Phone:415-259-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
HILCSW45941041C0700X
FLLCSW218091041C0700X
CALCSW859931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical