Healthcare Provider Details

I. General information

NPI: 1679707467
Provider Name (Legal Business Name): SARAH R BRINDAMOUR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH R KOSTRUB LCSW

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NE MIZNER BLVD
BOCA RATON FL
33432-4008
US

IV. Provider business mailing address

1417 SE 4TH ST
FT LAUDERDALE FL
33301-2319
US

V. Phone/Fax

Practice location:
  • Phone: 561-272-6322
  • Fax: 954-770-1643
Mailing address:
  • Phone: 561-272-6322
  • Fax: 954-779-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: