Provider Demographics
NPI:1194172643
Name:NESSOLA, LAURA ELAINE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELAINE
Last Name:NESSOLA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10362 S MCCLUNG LOOP
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-5553
Mailing Address - Country:US
Mailing Address - Phone:352-345-9948
Mailing Address - Fax:352-503-5183
Practice Address - Street 1:155 DOUGLAS ST STE A
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-3854
Practice Address - Country:US
Practice Address - Phone:352-345-9948
Practice Address - Fax:352-503-5183
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-14
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW137241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical