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General NPI Number Information
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NPI Number | 1841750197
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Entity Type | Individual
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Provider Name | STACIA ANN VAN BAALEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 19001 SW 106TH AVE # C-103
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City | CUTLER BAY
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State | FL
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Zip | 33157-7669
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Country | US
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Telephone | 786-227-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 13041 SW 95TH AVE
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City | MIAMI
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State | FL
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Zip | 33176-5728
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Country | US
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Telephone | 305-282-1531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | SW5993
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License Number State | FL
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