Provider Demographics
NPI:1710104385
Name:MAYER, ERIC (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MAYER
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 1:5301 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4611
Mailing Address - Country:US
Mailing Address - Phone:954-987-7089
Mailing Address - Fax:
Practice Address - Street 1:5301 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-4611
Practice Address - Country:US
Practice Address - Phone:954-987-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW80551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical