Provider Demographics
NPI:1306959796
Name:GANON, LORRAINE A (LCSW DCSW)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:A
Last Name:GANON
Suffix:
Gender:F
Credentials:LCSW DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 SHERIDAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3622
Mailing Address - Country:US
Mailing Address - Phone:954-964-5959
Mailing Address - Fax:954-986-4457
Practice Address - Street 1:3870 SHERIDAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3622
Practice Address - Country:US
Practice Address - Phone:954-964-5959
Practice Address - Fax:954-986-4457
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00020671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4146Medicare ID - Type Unspecified