Healthcare Provider Details

I. General information

NPI: 1568531994
Provider Name (Legal Business Name): STEPHANIE RACHEL KANE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 NE 19TH AVE STE 205
FT LAUDERDALE FL
33304-3070
US

IV. Provider business mailing address

941 NE 19TH AVE STE 205
FT LAUDERDALE FL
33304-3070
US

V. Phone/Fax

Practice location:
  • Phone: 954-504-7756
  • Fax:
Mailing address:
  • Phone: 954-504-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number0000004681
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number040086254
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37FI00168300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49989
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number778871
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number474472101
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 2912
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1239796
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC 140
License Number StateCA
# 10
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPMH 1195
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC000494500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: