Provider Demographics
NPI:1679804538
Name:CHILDS, JOAN E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:E
Last Name:CHILDS
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 1:1040 BAYVIEW DR STE 408
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2542
Mailing Address - Country:US
Mailing Address - Phone:954-568-1004
Mailing Address - Fax:954-925-2613
Practice Address - Street 1:1040 BAYVIEW DR
Practice Address - Street 2:408
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2522
Practice Address - Country:US
Practice Address - Phone:954-568-1004
Practice Address - Fax:954-925-9613
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00006221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical