Individual provider Active NPI

Laura Ida Anthony, LCSW

  • Clinical Social Worker
  • St Petersburg, FL
National Provider Identifier
1114404506
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW22193 Issued in FL
Practice address
7901 4TH St N # 29161
St Petersburg, FL 33702-4305
Phone
(727) 428-8288
Fax
(727) 295-1938
NPI assigned
Jul 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C013404 NC
Clinical Social Worker 1041C0700X 9630 TN
Clinical Social Worker 1041C0700X SW22193 FL Primary
Clinical Social Worker 1041C0700X 0904017875 VA

Addresses

Primary practice location

7901 4TH St N # 29161
St Petersburg, FL 33702-4305

Mailing address

12773 Mangrove Forest Dr
Riverview, FL 33579-2455
Phone (727) 428-8288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201016000527 NC Practitioner - Clinical Social Worker 4587084371 Reassigns benefits to 1 organization
Practice locations: Charlotte, NC
I20231204003669 FL Practitioner - Clinical Social Worker 4587084371

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C013404NCMDClinical Social Worker
0904017875VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Vitae Health Medical Florida PLLC Clinical CurrentSince Nov 1, 2023 Accepting new patients
Cotler Healthcare & Development Inc. CurrentSince Aug 25, 2025 Accepting new patients
Mindful Mental Health Services - FL Gulf SW LLC Clinical CurrentSince May 15, 2024 Accepting new patients
Collaborative Counseling Services, PLLC Mental Health CurrentSince Oct 6, 2020 Accepting new patients

Locations

901 S 62nd Ave
Hollywood, FL 33023
Phone (954) 893-0109

9835 Lake Worth Rd
Ste 16179
Lake Worth, FL 33467

5350 Gulf of Mexico Dr
Ste 203
Longboat Key, FL 34228
Phone (941) 210-0384

4500 Indianapolis St NE
St Petersburg, FL 33703
Phone (727) 209-4600

2811 Campus Hill Dr
Tampa, FL 33612
Phone (813) 972-9700

303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347

301 S McDowell St
Charlotte, NC 28204
Phone (704) 900-0548

10130 Mallard Creek Rd
Ste 300
Charlotte, NC 28262
Phone (704) 944-3533

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776902400000",
    "number": "1114404506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12773 MANGROVE FOREST DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335792455",
            "telephone_number": "727-428-8288",
            "fax_number": "727-295-1938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 4TH ST N # 29161",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337024305",
            "telephone_number": "727-428-8288",
            "fax_number": "727-295-1938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTHONY",
        "first_name": "LAURA",
        "middle_name": "IDA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-27",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C013404",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "9630",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW22193",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904017875",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.