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Individual

DENNA LANTZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544
(850) 884-7965
Mailing address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(850) 884-7965

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW11717
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
HR100Z
MEDICARE PTAN
FL
Enumeration date
12/11/2013
Last updated
05/23/2018
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