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NPI Code Detail

MEDICARE: STACIE PORITZ

MEDICARE: STACIE PORITZ
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689085995
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIE PORITZ
Provider Business Mailing Address
First Line : 4781 N CONGRESS AVE # 2145
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-7941
Country : US
Telephone Number : 561-788-5288
Fax Number :
Provider Business Practice Location Address
First Line : 2500 N MILITARY TRL STE 304
Second Line :
City : BOCA RATON
State : FL
Zip : 33431-6324
Country : US
Telephone Number : 561-788-5288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2014
Last Update Date : 02/05/2025

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Directions to “ STACIE PORITZ ” Practice Location

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