Provider Demographics
NPI:1043303621
Name:WOOLFSTEAD, JAY SAMUEL (MS)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:SAMUEL
Last Name:WOOLFSTEAD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 GRIFFIN ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-436-8326
Mailing Address - Fax:954-433-0603
Practice Address - Street 1:10400 GRIFFIN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-436-8326
Practice Address - Fax:954-433-0603
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 0954101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7101OtherBC/BS