Provider Demographics
NPI:1407927346
Name:DEMAURO, PAULA G (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:G
Last Name:DEMAURO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 TAMIAMI TRL S
Mailing Address - Street 2:SUITE 401A
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5562
Mailing Address - Country:US
Mailing Address - Phone:941-488-5621
Mailing Address - Fax:
Practice Address - Street 1:1505 TAMIAMI TRL S
Practice Address - Street 2:SUITE 401A
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5562
Practice Address - Country:US
Practice Address - Phone:941-488-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW20621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6874Medicare ID - Type Unspecified