Provider Demographics
NPI:1982892253
Name:PETRAS, MARY L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:PETRAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 SW 220 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-3016
Mailing Address - Country:US
Mailing Address - Phone:305-256-6275
Mailing Address - Fax:305-256-6278
Practice Address - Street 1:11000 SW 220TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33170-3016
Practice Address - Country:US
Practice Address - Phone:305-256-6275
Practice Address - Fax:305-256-6278
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7744172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker