Healthcare Provider Details

I. General information

NPI: 1285109058
Provider Name (Legal Business Name): WILTSHIRE HINDS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SE MARTIN SQUARE CORPORATE PKWY
STUART FL
34994-4916
US

IV. Provider business mailing address

2801 SE MARTIN SQUARE CORPORATE PKWY
STUART FL
34994-4916
US

V. Phone/Fax

Practice location:
  • Phone: 772-888-3025
  • Fax: 772-266-4173
Mailing address:
  • Phone: 772-888-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW15477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: