Provider Demographics
NPI:1902254006
Name:AZOULAY, STUART LYLE (MS, LMFT, CAP)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:LYLE
Last Name:AZOULAY
Suffix:
Gender:M
Credentials:MS, LMFT, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-9002
Mailing Address - Country:US
Mailing Address - Phone:954-822-0444
Mailing Address - Fax:
Practice Address - Street 1:1510 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-9002
Practice Address - Country:US
Practice Address - Phone:954-822-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-003944-2014101YA0400X
FLMT3179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)