Provider Demographics
NPI:1316962657
Name:STAUBER, PATRICIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:STAUBER
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 1:1521 ALTON RD
Mailing Address - Street 2:SUITE 166
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3301
Mailing Address - Country:US
Mailing Address - Phone:305-710-7894
Mailing Address - Fax:305-532-7651
Practice Address - Street 1:1521 ALTON RD
Practice Address - Street 2:SUITE 166
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3301
Practice Address - Country:US
Practice Address - Phone:305-710-7894
Practice Address - Fax:305-532-7651
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW59261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7337Medicare ID - Type Unspecified