Provider Demographics
NPI:1265914188
Name:LAURO, VINCENT THOMAS (CADC-II ICADC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:THOMAS
Last Name:LAURO
Suffix:
Gender:M
Credentials:CADC-II ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22219 PALOS VERDES BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2016
Mailing Address - Country:US
Mailing Address - Phone:310-993-9487
Mailing Address - Fax:
Practice Address - Street 1:22219 PALOS VERDES BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2016
Practice Address - Country:US
Practice Address - Phone:310-993-9487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA05088021101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA05088021OtherCCAPP
CACI20440818OtherCCAPP