MEDICARE: MRS. STEPHENIE RENEE CRAIG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW16533	FL
2	1041C0700X	Clinical Social Worker	3136	OK

General Provider Information

NPI Number	:	1245372952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHENIE RENEE CRAIG LCSW

Provider Business Mailing Address
First Line	:	301 WAYNE TRL
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-5043
Country	:	US
Telephone Number	:	918-221-9987
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 WAYNE TRL
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-5043
Country	:	US
Telephone Number	:	918-221-9987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/27/2020

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