Provider Demographics
NPI:1609812072
Name:WALDMAN, STUART NEAL (LSCSW, LCSW)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:NEAL
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:LSCSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8629 BLUEJACKET ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1604
Mailing Address - Country:US
Mailing Address - Phone:913-677-3553
Mailing Address - Fax:913-677-3282
Practice Address - Street 1:8629 BLUEJACKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1604
Practice Address - Country:US
Practice Address - Phone:913-677-3553
Practice Address - Fax:913-677-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0059291041C0700X
KS20231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200424480BMedicaid
KS11569650OtherCAQH