Provider Demographics
NPI:1548031164
Name:DEFREITAS ROBERTO, MAURO LUCIO (MHP)
Entity type:Individual
Prefix:
First Name:MAURO LUCIO
Middle Name:
Last Name:DEFREITAS ROBERTO
Suffix:
Gender:M
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 NEWTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5608
Mailing Address - Country:US
Mailing Address - Phone:267-296-6354
Mailing Address - Fax:
Practice Address - Street 1:5043 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2644
Practice Address - Country:US
Practice Address - Phone:215-744-4343
Practice Address - Fax:215-744-8731
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health