MEDICARE: LARRY P. 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

General Provider Information

NPI Number	:	1710398417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY P. AUERBACH, LCSW

Provider Business Mailing Address
First Line	:	1801 SE HILLMOOR DR
Second Line	:	SUITE B-106
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7553
Country	:	US
Telephone Number	:	772-335-3100
Fax Number	:	772-335-3700

Provider Business Practice Location Address
First Line	:	1801 SE HILLMOOR DR
Second Line	:	SUITE B-106
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7553
Country	:	US
Telephone Number	:	772-335-3100
Fax Number	:	772-335-3700

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	LARRY PHILLIP AUERBACH
Credential	:	LCSW
Telephone Number	:	772-335-3100

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	05/15/2014

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