Provider Demographics
NPI:1154469658
Name:SPANGENBERG, STUART FERRIDAY (MSW)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:FERRIDAY
Last Name:SPANGENBERG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 RAYMOND ST
Mailing Address - Street 2:CROSSROADS ANNEX
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-8208
Mailing Address - Country:US
Mailing Address - Phone:407-621-2609
Mailing Address - Fax:407-621-2609
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:CROSSROADS ANNEX
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-621-2609
Practice Address - Fax:407-621-2609
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5458104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0609AMedicare ID - Type Unspecified