Individual
DANIEL S MIRTENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EDM, PSYD
Contact information
Practice address
1848 SE 1ST AVE, FORT LAUDERDALE, FL 33316-2875
(954) 885-9500
Mailing address
1848 SE 1ST AVE, FORT LAUDERDALE, FL 33316-2875
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY9965
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PY9965
FLDOH
FL
Enumeration date
09/18/2017
Last updated
07/21/2022
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