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General NPI Number Information
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NPI Number | 1073056792
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Entity Type | Individual
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Provider Name | STEPHANIE NUNEZ
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Gender | Female
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 07/02/2023
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Provider Practice Location Address
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Address Line | 2222 COLONIAL RD STE 100
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City | FORT PIERCE
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State | FL
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Zip | 34950-5309
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Country | US
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Telephone | 772-489-4726
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Fax |
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Provider Business Mailing Address
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Address Line | 6456 NW FLAIR ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-3791
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Country | US
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Telephone | 305-399-8177
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Fax |
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | M635-781-93-724-0
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | M635-781-93-724-0
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | M635-781-93-724-0
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License Number State | FL
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