Provider Demographics
NPI:1356881544
Name:AYUSO, AURELIO (LCSW)
Entity type:Individual
Prefix:MR
First Name:AURELIO
Middle Name:
Last Name:AYUSO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 SW BUFFUM LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3529
Mailing Address - Country:US
Mailing Address - Phone:772-337-8500
Mailing Address - Fax:772-338-8505
Practice Address - Street 1:725 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-9125
Practice Address - Country:US
Practice Address - Phone:772-252-4014
Practice Address - Fax:772-999-5577
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW13870101YM0800X, 101YP2500X, 1041C0700X, 101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103672400Medicaid