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Individual

MRS. LAURA ANN STAFFORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LICSW

Contact information

Practice address
12550 NEW BRITTANY BLVD, SUITE 201, FORT MYERS, FL 33907-3655
(239) 343-9190
Mailing address
12550 NEW BRITTANY BLVD, SUITE 201, FORT MYERS, FL 33907-3655
(239) 343-9190

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
111844
MA

Other

Enumeration date
05/06/2009
Last updated
04/01/2015
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