Healthcare Provider Details

I. General information

NPI: 1548212996
Provider Name (Legal Business Name): HENRY HIMMELBAUM L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HENRY NMN HIMMELBAUM L.C.S.W.

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 MONACO COURT, BLDG N
DELRAY BEACH FL
33446-1949
US

IV. Provider business mailing address

666 MONACO COURT, BLDG N
DELRAY BEACH FL
33446-1949
US

V. Phone/Fax

Practice location:
  • Phone: 561-716-4840
  • Fax: 954-431-0413
Mailing address:
  • Phone: 561-716-4840
  • Fax: 954-431-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 3203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: