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Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIRSTEN LYNGVED SHEA LCSW (PRESIDENT)
(786) 683-4331
Entity
Organization

Contact information

Practice address
511 SE 5TH AVE, APT. 1812, FT LAUDERDALE, FL 33301-2984
(786) 683-4331
Mailing address
511 SE 5TH AVE, APT. 1812, FT LAUDERDALE, FL 33301-2984
(786) 683-4331

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
SW 10044
FL

Other

Enumeration date
10/06/2010
Last updated
02/13/2012
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