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General NPI Number Information
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NPI Number | 1710398417
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Entity Type | Organization
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Legal Business Name | LARRY P. AUERBACH, LCSW
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 1801 SE HILLMOOR DR SUITE B-106
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7553
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Country | US
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Telephone | 772-335-3100
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Fax | 772-335-3700
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Provider Business Mailing Address
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Address Line | 1801 SE HILLMOOR DR SUITE B-106
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7553
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Country | US
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Telephone | 772-335-3100
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Fax | 772-335-3700
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | LARRY PHILLIP AUERBACH
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Credential | LCSW
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Telephone | 772-335-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW3615
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License Number State | FL
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