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General NPI Number Information
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NPI Number | 1750762530
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Entity Type | Individual
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Provider Name | STEPHANIE GRACE HAFFIELD LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 2001 W BLUE HERON BLVD
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-5003
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Country | US
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Telephone | 561-841-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 506 SE KYLE RD
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-6237
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Country | US
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Telephone | 772-486-5143
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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 | SW12400
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW-12400
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License Number State | FL
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