Provider Demographics
NPI:1437454212
Name:VANDERSTINE, WILLIAM NICHOLAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:NICHOLAS
Last Name:VANDERSTINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3800 S TAMIAMI TRL UNIT 210
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6909
Mailing Address - Country:US
Mailing Address - Phone:941-525-0157
Mailing Address - Fax:941-922-7574
Practice Address - Street 1:3800 S TAMIAMI TRL UNIT 210
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6909
Practice Address - Country:US
Practice Address - Phone:941-525-0157
Practice Address - Fax:941-922-7574
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW100941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical