Provider Demographics
NPI:1912248154
Name:EJENBAUM, MARITZA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARITZA
Middle Name:
Last Name:EJENBAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARITZA
Other - Middle Name:
Other - Last Name:EJENBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:7430 GARY AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2510
Mailing Address - Country:US
Mailing Address - Phone:305-458-9224
Mailing Address - Fax:
Practice Address - Street 1:333 W 41ST ST
Practice Address - Street 2:SUITE 208-210
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3641
Practice Address - Country:US
Practice Address - Phone:305-672-8080
Practice Address - Fax:305-672-0030
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 29931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical