MEDICARE: STEPHANIE BERLYN GUISE 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	SW19028	FL

General Provider Information

NPI Number	:	1760143887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BERLYN GUISE LCSW

Provider Business Mailing Address
First Line	:	4678 LOVEGRASS LN
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-8357
Country	:	US
Telephone Number	:	972-837-0065
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 SHOREVIEW DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-8950
Country	:	US
Telephone Number	:	972-837-0065
Fax Number	:

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

Provider Enumeration Date	:	01/02/2022
Last Update Date	:	06/19/2023

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