Individual provider Active NPI

Wendy Fier Lustgarten, LCSW

  • Clinical Social Worker
  • Stuart, FL
National Provider Identifier
1962568790
Registry record updated May 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW5963 Issued in FL
Practice address
834 SE Ocean Blvd
Stuart, FL 34994-2428
Phone
(772) 220-1629
NPI assigned
Dec 28, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 25, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW5963 FL Primary

Addresses

Primary practice location

834 SE Ocean Blvd
Stuart, FL 34994-2428

Mailing address

834 SE Ocean Blvd
Stuart, FL 34994-2428
Phone (772) 260-0039

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080905000278 FL Practitioner - Clinical Social Worker 5597831115 Practice locations: Port St Lucie, FL; Stuart, FL

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW5963FLMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464134400000",
    "number": "1962568790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 SE OCEAN BLVD",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349942428",
            "telephone_number": "772-260-0039",
            "fax_number": "772-288-0878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 SE OCEAN BLVD",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349942428",
            "telephone_number": "772-220-1629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSTGARTEN",
        "first_name": "WENDY",
        "middle_name": "FIER",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2016-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW5963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

Verify at the official NPI Registry.