Provider Demographics
NPI:1407080120
Name:FRUSTACI, DARA A (LCSW)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:A
Last Name:FRUSTACI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 YARMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7660
Mailing Address - Country:US
Mailing Address - Phone:561-795-0485
Mailing Address - Fax:
Practice Address - Street 1:1035 S STATE ROAD 7
Practice Address - Street 2:SUITE 315-21
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6134
Practice Address - Country:US
Practice Address - Phone:561-714-8618
Practice Address - Fax:561-828-9272
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW89651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical