Provider Demographics
NPI:1669603221
Name:PACE, LAMORA D (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAMORA
Middle Name:D
Last Name:PACE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LAMORA
Other - Middle Name:D
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, CAP
Mailing Address - Street 1:2500 HOLLYWOOD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6615
Mailing Address - Country:US
Mailing Address - Phone:754-777-6871
Mailing Address - Fax:965-906-3619
Practice Address - Street 1:2500 HOLLYWOOD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6615
Practice Address - Country:US
Practice Address - Phone:754-777-6871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP ADC-001430-2014101YA0400X
FL251B00000X
FLSW94591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017670800Medicaid