MEDICARE: DR. STEPHEN VINSON EDD, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	112522	TX
2	1041C0700X	Clinical Social Worker	SW22455	FL

General Provider Information

NPI Number	:	1104555994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN VINSON EDD, LCSW

Provider Business Mailing Address
First Line	:	10062 NAVARRE PKWY # 5003
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-3013
Country	:	US
Telephone Number	:	850-604-3574
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-5623
Country	:	US
Telephone Number	:	850-604-3574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	06/20/2025

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