Provider Demographics
NPI:1962790857
Name:STURDEVANT, LAURA M (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:STURDEVANT
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 246
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34447-0246
Mailing Address - Country:US
Mailing Address - Phone:352-322-2550
Mailing Address - Fax:
Practice Address - Street 1:101 S OSCEOLA AVE STE 2
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4727
Practice Address - Country:US
Practice Address - Phone:352-322-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2024-11-15
Deactivation Date:2022-04-20
Deactivation Code:
Reactivation Date:2022-06-22
Provider Licenses
StateLicense IDTaxonomies
NY0822571041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical