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General NPI Number Information
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NPI Number | 1215021860
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Entity Type | Individual
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Provider Name | STEPHANIE OWEN MORENO LMFT, ATR-BC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2231 N. UNIVERSITY DR. SUITE C
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City | PEMBROKE PINES
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-989-8818
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Fax | 954-989-8812
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Provider Business Mailing Address
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Address Line | 1445 NW 10 ST.
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City | DANIA BEACH
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State | FL
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Zip | 33004-2342
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Country | US
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Telephone | 954-920-0391
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 2143
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License Number State | FL
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