Provider Demographics
NPI:1710398417
Name:LARRY P. AUERBACH, LCSW
Entity Type:Organization
Organization Name:LARRY P. AUERBACH, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-335-3100
Mailing Address - Street 1:1801 SE HILLMOOR DR
Mailing Address - Street 2:SUITE B-106
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7553
Mailing Address - Country:US
Mailing Address - Phone:772-335-3100
Mailing Address - Fax:772-335-3700
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:SUITE B-106
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:772-335-3100
Practice Address - Fax:772-335-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW36151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5946Medicare UPIN