Provider Demographics
NPI:1700802436
Name:MAIZLER, JAN S (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAN
Middle Name:S
Last Name:MAIZLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19496 E COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4826
Mailing Address - Country:US
Mailing Address - Phone:305-940-1564
Mailing Address - Fax:305-571-9506
Practice Address - Street 1:3050 BISCAYNE BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4158
Practice Address - Country:US
Practice Address - Phone:305-940-1564
Practice Address - Fax:305-571-9506
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00000941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2031Medicare PIN