MEDICARE: BETHANY ANN STAZZONE I RMFT

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	101Y00000X	Counselor	4394	FL

General Provider Information

NPI Number	:	1295623890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY ANN STAZZONE I RMFT

Provider Business Mailing Address
First Line	:	192 GRAY DOVE CT
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1390
Country	:	US
Telephone Number	:	732-703-0381
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 SUMMERHAVEN DR
Second Line	:
City	:	DEBARY
State	:	FL
Zip	:	32713-2755
Country	:	US
Telephone Number	:	732-703-0381
Fax Number	:

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

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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