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General NPI Number Information
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NPI Number | 1487548384
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Entity Type | Individual
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Provider Name | MS. STEPHANIE ROQUE
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Gender | Female
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 1280 SW 36TH AVE STE 207
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City | POMPANO BEACH
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State | FL
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Zip | 33069-4838
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Country | US
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Telephone | 561-408-1098
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Fax |
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Provider Business Mailing Address
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Address Line | 8064 W 15TH CT
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City | HIALEAH
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State | FL
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Zip | 33014-3337
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Country | US
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Telephone | 305-409-0553
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH25706
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License Number State | FL
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