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General NPI Number Information
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NPI Number | 1831786086
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Entity Type | Individual
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Provider Name | STEPHANIE MAUREEN GROGG MS
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Gender | Female
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 224 DATURA ST STE 1015
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5638
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Country | US
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Telephone | 772-202-6742
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Fax |
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Provider Business Mailing Address
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Address Line | 950 S KANNER HWY APT TH18
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City | STUART
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State | FL
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Zip | 34994-3722
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Country | US
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Telephone | 561-685-6128
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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 | 18431
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19379
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License Number State | FL
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