Provider Demographics
NPI:1912162439
Name:VANSLUYTMAN, /STALBURN ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:/STALBURN
Middle Name:ANTHONY
Last Name:VANSLUYTMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SW FEDERAL HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2925
Mailing Address - Country:US
Mailing Address - Phone:772-579-7825
Mailing Address - Fax:
Practice Address - Street 1:200 TREASURE CAY DR
Practice Address - Street 2:2-303
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-5336
Practice Address - Country:US
Practice Address - Phone:772-579-7825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW43781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical