Provider Demographics
NPI:1316392871
Name:TABORGA, MAURICIO RICHARD (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:MAURICIO
Middle Name:RICHARD
Last Name:TABORGA
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 BRICKELL AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3436
Mailing Address - Country:US
Mailing Address - Phone:703-786-5425
Mailing Address - Fax:801-217-5748
Practice Address - Street 1:1428 BRICKELL AVE STE 403
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131
Practice Address - Country:US
Practice Address - Phone:305-915-5748
Practice Address - Fax:801-217-5748
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health