MEDICARE: STEPHANIE PAUGH

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH11925	FL
2	103K00000X	Behavior Analyst
3	101YM0800X	Mental Health Counselor	MH11925	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1922460450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PAUGH

Provider Business Mailing Address
First Line	:	1510 CLOVERLAWN AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2444
Country	:	US
Telephone Number	:	407-797-0730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 CLOVERLAWN AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2444
Country	:	US
Telephone Number	:	407-797-0730
Fax Number	:

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	10/17/2020

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Directions to “ STEPHANIE PAUGH ” Practice Location

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