Provider Demographics
NPI:1932277290
Name:MUTCHNICK, STEVEN A (LCSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:MUTCHNICK
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 1:1140 NW 100TH WAY
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6522
Mailing Address - Country:US
Mailing Address - Phone:954-661-3735
Mailing Address - Fax:954-693-0673
Practice Address - Street 1:2 S UNIVERSITY DR
Practice Address - Street 2:SUITE304
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3355
Practice Address - Country:US
Practice Address - Phone:954-661-3735
Practice Address - Fax:954-693-0673
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00001001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2842Medicare ID - Type Unspecified