Provider Demographics
NPI:1699920090
Name:EGBERT, NANCY L (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:EGBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5307
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-0041
Mailing Address - Country:US
Mailing Address - Phone:813-431-1567
Mailing Address - Fax:
Practice Address - Street 1:1801 E MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2226
Practice Address - Country:US
Practice Address - Phone:863-686-7153
Practice Address - Fax:863-683-5515
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW87571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW8757OtherLICENSED CLINICAL SOCIAL WORKER