Provider Demographics
NPI:1962568790
Name:LUSTGARTEN, WENDY FIER (LCSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:FIER
Last Name:LUSTGARTEN
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 1:834 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2428
Mailing Address - Country:US
Mailing Address - Phone:772-260-0039
Mailing Address - Fax:772-288-0878
Practice Address - Street 1:834 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2428
Practice Address - Country:US
Practice Address - Phone:772-220-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW59631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical