MEDICARE: MR. HENRY HIMMELBAUM L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW 3203	FL

General Provider Information

NPI Number	:	1548212996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HENRY HIMMELBAUM L.C.S.W.

Provider Business Mailing Address
First Line	:	666 MONACO COURT, BLDG N
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-1949
Country	:	US
Telephone Number	:	561-716-4840
Fax Number	:	954-431-0413

Provider Business Practice Location Address
First Line	:	666 MONACO COURT, BLDG N
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-1949
Country	:	US
Telephone Number	:	561-716-4840
Fax Number	:	954-431-0413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	11/20/2012

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