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NPI Code Detail

MEDICARE: MR. DONALD JOHN FENSTERMAN LCSW

MEDICARE: MR. DONALD JOHN FENSTERMAN LCSW
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
1101YM0800XMental Health CounselorSW17996FL
21041C0700XClinical Social Worker21372CA

General Provider Information

NPI Number : 1972764025
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD JOHN FENSTERMAN LCSW
Provider Business Mailing Address
First Line : 4740 N STATE ROAD 7 STE 201
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33319-5839
Country : US
Telephone Number : 954-486-4005
Fax Number :
Provider Business Practice Location Address
First Line : 2900 W PROSPECT RD
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-2519
Country : US
Telephone Number : 954-731-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2008
Last Update Date : 03/05/2026

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