Provider Demographics
NPI:1073968665
Name:DEBORAH MARCUS STAYMAN LLC
Entity type:Organization
Organization Name:DEBORAH MARCUS STAYMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LCSW
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-775-5017
Mailing Address - Street 1:4330 NORTH HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:305-902-7662
Mailing Address - Fax:954-986-1281
Practice Address - Street 1:19300 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-2201
Practice Address - Country:US
Practice Address - Phone:305-902-7662
Practice Address - Fax:954-986-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW128591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty