Provider Demographics
NPI:1104139518
Name:STAUM, MINDY (LCSW)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:STAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 N UNIVERSITY DR
Mailing Address - Street 2:STE 102
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4638
Mailing Address - Country:US
Mailing Address - Phone:954-464-1393
Mailing Address - Fax:
Practice Address - Street 1:5421 N UNIVERSITY DR STE 102
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4638
Practice Address - Country:US
Practice Address - Phone:954-464-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW99411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical