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NPI Code Detail

MEDICARE: STEPHANIE MODARELLI LCSW, LCDC

MEDICARE: STEPHANIE MODARELLI LCSW, LCDC
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
11041C0700XClinical Social Worker64817TX

General Provider Information

NPI Number : 1396356150
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE MODARELLI LCSW, LCDC
Provider Business Mailing Address
First Line : 511 E JOHN CARPENTER FWY STE 500
Second Line :
City : IRVING
State : TX
Zip : 75062-8138
Country : US
Telephone Number : 972-719-2501
Fax Number :
Provider Business Practice Location Address
First Line : 511 E JOHN CARPENTER FWY STE 500
Second Line :
City : IRVING
State : TX
Zip : 75062-8138
Country : US
Telephone Number : 972-719-2501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2020
Last Update Date : 04/16/2024

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