Provider Demographics
NPI:1942541958
Name:VAUGHN, LILA GALE (LCSW)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:GALE
Last Name:VAUGHN
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 1:5011 SAGO PALM CIR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3152
Mailing Address - Country:US
Mailing Address - Phone:954-625-3898
Mailing Address - Fax:
Practice Address - Street 1:5011 SAGO PALM CIR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-3152
Practice Address - Country:US
Practice Address - Phone:954-625-3898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW112521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical