Provider Demographics
NPI:1821115775
Name:HANK HIMMELBAUM LCSW PA
Entity Type:Organization
Organization Name:HANK HIMMELBAUM LCSW PA
Other - Org Name:HENRY HIMMELBAUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HANK
Authorized Official - Middle Name:
Authorized Official - Last Name:HIMMELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-447-7501
Mailing Address - Street 1:6893 SW 18TH ST
Mailing Address - Street 2:F-101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7044
Mailing Address - Country:US
Mailing Address - Phone:561-447-7501
Mailing Address - Fax:561-447-7621
Practice Address - Street 1:6893 SW 18TH ST
Practice Address - Street 2:F-101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7044
Practice Address - Country:US
Practice Address - Phone:561-447-7501
Practice Address - Fax:561-447-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 3203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1739Medicare ID - Type UnspecifiedGROUP NUMBER