Healthcare Provider Details

I. General information

NPI: 1720745151
Provider Name (Legal Business Name): STEPPING STONE HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W HALLANDALE BEACH BLVD STE 457
HALLANDALE BEACH FL
33009-5441
US

IV. Provider business mailing address

221 W HALLANDALE BEACH BLVD STE 457
HALLANDALE BEACH FL
33009-5441
US

V. Phone/Fax

Practice location:
  • Phone: 954-234-2670
  • Fax:
Mailing address:
  • Phone: 954-234-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACI-ANN MILLER
Title or Position: ONWER
Credential: ARNP
Phone: 754-799-7991