Provider Demographics
NPI:1679805097
Name:BROYLES, LAURI D (MSW)
Entity type:Individual
Prefix:MRS
First Name:LAURI
Middle Name:D
Last Name:BROYLES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13340 MEADOW LARK TER
Mailing Address - Street 2:
Mailing Address - City:ASTATULA
Mailing Address - State:FL
Mailing Address - Zip Code:34705-9370
Mailing Address - Country:US
Mailing Address - Phone:352-404-9609
Mailing Address - Fax:352-404-9609
Practice Address - Street 1:13340 MEADOW LARK TER
Practice Address - Street 2:
Practice Address - City:ASTATULA
Practice Address - State:FL
Practice Address - Zip Code:34705-9370
Practice Address - Country:US
Practice Address - Phone:352-404-9609
Practice Address - Fax:352-404-9609
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker