MEDICARE: MR. RICHARD ANTHONY MAYORA 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	SW 7038	FL
2	1041C0700X	Clinical Social Worker	SW7038	FL

General Provider Information

NPI Number	:	1467625517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD ANTHONY MAYORA LCSW

Provider Business Mailing Address
First Line	:	915 MIDDLE RIVER DR STE 307
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3560
Country	:	US
Telephone Number	:	954-566-2166
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 MIDDLE RIVER DR STE 307
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3560
Country	:	US
Telephone Number	:	954-566-2166
Fax Number	:

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

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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