Provider Demographics
NPI:1083922561
Name:MINDY STAUM, LCSW, P.A
Entity Type:Organization
Organization Name:MINDY STAUM, LCSW, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-464-1393
Mailing Address - Street 1:5421 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4638
Mailing Address - Country:US
Mailing Address - Phone:954-464-1393
Mailing Address - Fax:954-340-6859
Practice Address - Street 1:5421 N UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4638
Practice Address - Country:US
Practice Address - Phone:954-464-1393
Practice Address - Fax:954-340-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-19
Last Update Date:2018-10-12
Deactivation Date:2018-10-09
Deactivation Code:
Reactivation Date:2018-10-12
Provider Licenses
StateLicense IDTaxonomies
FLSW99411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty