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General NPI Number Information
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NPI Number | 1083922561
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Entity Type | Organization
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Legal Business Name | MINDY STAUM, LCSW, P.A
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Dates
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Enumeration Date | 09/19/2010
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 5421 N UNIVERSITY DR SUITE 102
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4638
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Country | US
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Telephone | 954-464-1393
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Fax | 954-340-6859
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Provider Business Mailing Address
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Address Line | 5421 N UNIVERSITY DR SUITE 102
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4638
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Country | US
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Telephone | 954-464-1393
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Fax | 954-340-6859
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Authorized Official
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Title or Position | PRESIDENT
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Name | MINDY STAUM
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Credential | LCSW
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Telephone | 954-464-1393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9941
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License Number State | FL
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