Provider Demographics
NPI:1285732867
Name:SPACKMAN, ANN SALAZAR (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:SALAZAR
Last Name:SPACKMAN
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 1:2163 W 73RD ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5551
Mailing Address - Country:US
Mailing Address - Phone:954-418-2751
Mailing Address - Fax:
Practice Address - Street 1:2163 W 73RD ST # 4
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5551
Practice Address - Country:US
Practice Address - Phone:305-825-3872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW111961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical