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General NPI Number Information
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NPI Number | 1912162439
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Entity Type | Individual
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Provider Name | /STALBURN ANTHONY VANSLUYTMAN L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 200 TREASURE CAY DR 2-303
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City | FORT PIERCE
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State | FL
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Zip | 34947-5336
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Country | US
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Telephone | 772-579-7825
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Fax |
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Provider Business Mailing Address
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Address Line | 611 SW FEDERAL HWY SUITE C
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City | STUART
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State | FL
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Zip | 34994-2925
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Country | US
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Telephone | 772-579-7825
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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 | SW4378
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License Number State | FL
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