Doctor Name: | LARRY KEITH MABRY |
NPI Number: | 1356513477 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.C.S.W. |
License Number: | SW4847 |
Business Practice Address: | 350 Celestial Way Juno Beach, FL - 334082302 |
Business Phone Number: | 5617764214 |
Business Fax Number: | |
Mailing Address: | 350 Celestial Way, JUNO BEACH |
State: | FL |
Postal Code: | 334082302 |
Phone Number: | 5617764214 |
Fax Number: | |
NPI Enumeration Date: | 03/28/2008 |
NPI Last Update Date: | 03/28/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | SW4847 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |