Provider Demographics
NPI:1881915577
Name:WALDMAN, FANNY (MS, LMFT)
Entity type:Individual
Prefix:
First Name:FANNY
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3309
Mailing Address - Country:US
Mailing Address - Phone:954-370-7028
Mailing Address - Fax:954-370-0883
Practice Address - Street 1:817 S UNIVERSITY DR
Practice Address - Street 2:SUITE 121
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3309
Practice Address - Country:US
Practice Address - Phone:954-370-7028
Practice Address - Fax:954-370-0883
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist