Healthcare Provider Details

I. General information

NPI: 1982935870
Provider Name (Legal Business Name): MICHAEL STAHL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2010
Last Update Date: 01/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19333 COLLINS AVE APT 1506
SUNNY ISLES BEACH FL
33160-2371
US

IV. Provider business mailing address

19333 COLLINS AVE APT 1506
SUNNY ISLES BEACH FL
33160-2371
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-6569
  • Fax: 305-935-6569
Mailing address:
  • Phone: 305-935-6569
  • Fax: 305-935-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW02555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: