Provider Demographics
NPI:1952629396
Name:MAURO, DONALD LAWRENCE (MFC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LAWRENCE
Last Name:MAURO
Suffix:
Gender:M
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 SAN VICENTE BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4946
Mailing Address - Country:US
Mailing Address - Phone:310-314-0277
Mailing Address - Fax:310-573-3781
Practice Address - Street 1:12011 SAN VICENTE BLVD STE 408
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4946
Practice Address - Country:US
Practice Address - Phone:310-314-0277
Practice Address - Fax:310-573-3781
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43356101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor