Provider Demographics
NPI:1093982092
Name:FORSTADT, DAVID LIONEL (PSYD, LPC, CASAC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LIONEL
Last Name:FORSTADT
Suffix:
Gender:M
Credentials:PSYD, LPC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 NE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1275
Mailing Address - Country:US
Mailing Address - Phone:716-908-3066
Mailing Address - Fax:
Practice Address - Street 1:805 E BROWARD BLVD STE 301
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2046
Practice Address - Country:US
Practice Address - Phone:323-205-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25987101YA0400X
COLPC.0016363101YM0800X
CALPCC.9293101YM0800X
FLMH.18797101YM0800X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health