Provider Demographics
NPI:1588815617
Name:CONGDON, DAVID CHARLES (LCSW)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:CONGDON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:CHARLES
Other - Last Name:CONGDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1520 BONNIE BURN CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5705
Mailing Address - Country:US
Mailing Address - Phone:407-740-7139
Mailing Address - Fax:407-740-7139
Practice Address - Street 1:1520 BONNIE BURN CIR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5705
Practice Address - Country:US
Practice Address - Phone:407-740-7139
Practice Address - Fax:407-740-7139
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00021501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical