Provider Demographics
NPI:1043490899
Name:REDLER, WALTER FABIAN (PSYD, LCSW)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:FABIAN
Last Name:REDLER
Suffix:
Gender:M
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:FABIAN
Other - Middle Name:
Other - Last Name:REDLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, LCSW
Mailing Address - Street 1:11510 INTERCHANGE CIR N
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6006
Mailing Address - Country:US
Mailing Address - Phone:954-237-0355
Mailing Address - Fax:866-632-6439
Practice Address - Street 1:11510 INTERCHANGE CIR N
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6006
Practice Address - Country:US
Practice Address - Phone:954-237-0355
Practice Address - Fax:866-632-6439
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5782101YM0800X, 101YP2500X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist