Provider Demographics
NPI:1346338175
Name:RAMIREZ, MAURICIO (LCSW)
Entity type:Individual
Prefix:MR
First Name:MAURICIO
Middle Name:
Last Name:RAMIREZ
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 1:2507 CALLAWAY RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5267
Mailing Address - Country:US
Mailing Address - Phone:850-644-5973
Mailing Address - Fax:850-848-4400
Practice Address - Street 1:2507 CALLAWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5268
Practice Address - Country:US
Practice Address - Phone:850-644-6543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 46591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8840OtherBC BS IDENTIFIER
FLZ8840OtherBC BS IDENTIFIER