Provider Demographics
NPI:1174537666
Name:FALDUTI, JAMES C (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:FALDUTI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BABCOCK TER
Mailing Address - Street 2:
Mailing Address - City:SELKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:12158-1905
Mailing Address - Country:US
Mailing Address - Phone:518-650-5771
Mailing Address - Fax:
Practice Address - Street 1:12590 WHITEHALL DR STE 3
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4680
Practice Address - Country:US
Practice Address - Phone:239-939-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL145341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC012976OtherLICENSED CLINICAL SOCIAL WORKER
NYR070725-01OtherLICENSED CLINICAL SOCIAL WORKER
FLSW14534OtherLICENSED CLINICAL SOCIAL WORKER