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General NPI Number Information
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NPI Number | 1629070438
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Entity Type | Individual
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Provider Name | FREDERICK LECOMPTE STEVENS JR. PHD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 1401 SE GOLDTREE DR SUITE 104
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7584
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Country | US
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Telephone | 772-398-4377
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Fax | 772-905-8526
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Provider Business Mailing Address
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Address Line | 1401 SE GOLDTREE DR SUITE 104
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7584
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Country | US
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Telephone | 772-398-4377
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Fax | 772-905-8526
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY4177
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License Number State | FL
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