Provider Demographics
NPI:1073636775
Name:MASTURZO, KEVIN VINCENT (LCSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:VINCENT
Last Name:MASTURZO
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 1:184 GALVESTON ST SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7138
Mailing Address - Country:US
Mailing Address - Phone:215-264-3755
Mailing Address - Fax:267-219-6956
Practice Address - Street 1:4031 DIXIE HWY NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3682
Practice Address - Country:US
Practice Address - Phone:321-622-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
PACW0156261041C0700X
FLSW145201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical