Individual provider Active NPI

Lorelle M Destefano, LCSW

  • Clinical Social Worker
  • Fort Benning, GA
National Provider Identifier
1194185165
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW16232 Issued in FL
Practice address
6600 Van Aalst Blvd
Fort Benning, GA 31905-2102
Phone
(850) 855-4523
NPI assigned
Mar 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 0904009238 VA
Clinical Social Worker 1041C0700X 0904009238 VA
Clinical Social Worker 1041C0700X SW16232 FL Primary

Addresses

Primary practice location

6600 Van Aalst Blvd
Fort Benning, GA 31905-2102

Mailing address

6600 Van Aalst Blvd
Fort Benning, GA 31905-2102
Phone (850) 855-4523

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20191218000142 FL Practitioner - Clinical Social Worker 0749574978 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW16232FLMDClinical Social Worker
0904009238VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of North Carolina, PC CurrentSince Feb 15, 2024 Accepting new patients
Optum Behavioral Care of North Carolina, P.C. Clinical CurrentSince Feb 15, 2024 Accepting new patients

Locations

7451 Wiles Rd
Ste 103
Coral Springs, FL 33067
Phone (954) 340-0173

1090 Tamiami Trl
Sarasota, FL 34236
Phone 94136308782005

4700 N Habana Ave
Ste 703
Tampa, FL 33614
Phone (813) 678-2373

Organizations & group practices 2

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": "1456963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1194185165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "850-855-4523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "850-855-4523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "LORELLE",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-03",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0904009238",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904009238",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW16232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Benning, GA

Sources for this page

Verify at the official NPI Registry.