Provider Demographics
NPI:1447915624
Name:MUGAVIN, LIAM THOMAS (LCSW)
Entity type:Individual
Prefix:
First Name:LIAM
Middle Name:THOMAS
Last Name:MUGAVIN
Suffix:
Gender:U
Credentials:LCSW
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:C
Other - Last Name:MUGAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:520 NE 20TH ST APT 1001
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2160
Mailing Address - Country:US
Mailing Address - Phone:786-708-1229
Mailing Address - Fax:
Practice Address - Street 1:520 NE 20TH ST APT 1001
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2160
Practice Address - Country:US
Practice Address - Phone:786-708-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL223081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical