1821115775 NPI number — HANK HIMMELBAUM LCSW PA

Table of content: (NPI 1821115775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821115775 NPI number — HANK HIMMELBAUM LCSW PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANK HIMMELBAUM LCSW PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HENRY HIMMELBAUM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821115775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6893 SW 18TH ST
Provider Second Line Business Mailing Address:
F-101
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33433-7044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-447-7501
Provider Business Mailing Address Fax Number:
561-447-7621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6893 SW 18TH ST
Provider Second Line Business Practice Location Address:
F-101
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33433-7044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-447-7501
Provider Business Practice Location Address Fax Number:
561-447-7621
Provider Enumeration Date:
03/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HIMMELBAUM
Authorized Official First Name:
HANK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-447-7501

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  SW 3203 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)