Healthcare Provider Details

I. General information

NPI: 1093017501
Provider Name (Legal Business Name): STEPHANIE ANN RASBACH M.A M.S. BCBA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 06/03/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S SWOOPE AVE STE 211
MAITLAND FL
32751-5786
US

IV. Provider business mailing address

274 E EAU GALLIE BLVD # 230
INDIAN HARBOUR BEACH FL
32937-4874
US

V. Phone/Fax

Practice location:
  • Phone: 407-622-0444
  • Fax:
Mailing address:
  • Phone: 407-421-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20409
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7662
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: