Provider Demographics
NPI:1356738371
Name:MAURO, KATHY DENISE (MS, LMHC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:DENISE
Last Name:MAURO
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 NW 167TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1369
Mailing Address - Country:US
Mailing Address - Phone:754-366-0734
Mailing Address - Fax:
Practice Address - Street 1:1775 S.FLAMING RD.
Practice Address - Street 2:SUITE #1
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-1369
Practice Address - Country:US
Practice Address - Phone:754-366-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health