Provider Demographics
NPI:1992072573
Name:MAURINO, LARA (LCSW)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:MAURINO
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 1:168 LUCKY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5318
Mailing Address - Country:US
Mailing Address - Phone:917-817-5726
Mailing Address - Fax:
Practice Address - Street 1:168 LUCKY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5318
Practice Address - Country:US
Practice Address - Phone:917-817-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054607001041C0700X
NY73485971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical