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General NPI Number Information
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NPI Number | 1033672621
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Entity Type | Individual
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Provider Name | STEPHANIE SLORAHN PETERSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 1101 GULF BREEZE PKW BLDG 2, STE 4
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City | GULF BREEZE
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State | FL
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Zip | 32561-4468
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Country | US
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Telephone | 850-203-0045
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Fax | 850-782-0656
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Provider Business Mailing Address
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Address Line | 1101 GULF BREEZE PKW BLDG 2, STE 4
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City | GULF BREEZE
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State | FL
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Zip | 32561-4468
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Country | US
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Telephone | 850-203-0045
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Fax | 850-782-0656
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW6593
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License Number State | FL
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