Provider Demographics
NPI:1134233661
Name:MAURO, LANCE KEITH (LCSW)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:KEITH
Last Name:MAURO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5341 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8167
Mailing Address - Country:US
Mailing Address - Phone:561-498-7542
Mailing Address - Fax:561-499-4378
Practice Address - Street 1:5341 W ATLANTIC AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8167
Practice Address - Country:US
Practice Address - Phone:561-498-7542
Practice Address - Fax:561-499-4378
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW38531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6453Medicare ID - Type Unspecified