Healthcare Provider Details

I. General information

NPI: 1346338175
Provider Name (Legal Business Name): MAURICIO RAMIREZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 CALLAWAY RD STE 101
TALLAHASSEE FL
32303-5268
US

IV. Provider business mailing address

2507 CALLAWAY RD
TALLAHASSEE FL
32303-5267
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-6543
  • Fax:
Mailing address:
  • Phone: 850-644-5973
  • Fax: 850-848-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 4659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: