Provider Demographics
NPI:1679707467
Name:BRINDAMOUR, SARAH R (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:BRINDAMOUR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:R
Other - Last Name:KOSTRUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1417 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2319
Mailing Address - Country:US
Mailing Address - Phone:561-272-6322
Mailing Address - Fax:954-779-1643
Practice Address - Street 1:100 NE MIZNER BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4008
Practice Address - Country:US
Practice Address - Phone:561-272-6322
Practice Address - Fax:954-770-1643
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW78371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical