MEDICARE: LARRY PHILLIP AUERBACH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW3615	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW3615	OTHER	FL	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1114983228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY PHILLIP AUERBACH LCSW

Provider Business Mailing Address
First Line	:	938 SW BAYSHORE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1840
Country	:	US
Telephone Number	:	772-343-9400
Fax Number	:	772-343-9800

Provider Business Practice Location Address
First Line	:	938 SW BAYSHORE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1840
Country	:	US
Telephone Number	:	772-343-9400
Fax Number	:	772-343-9800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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