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NPI Code Detail

MEDICARE: DR. STEPHEN VINSON EDD, LCSW-QS

MEDICARE: DR. STEPHEN VINSON EDD, LCSW-QS
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
11041C0700XClinical Social Worker112522TX
21041C0700XClinical Social WorkerSW22455FL
31041C0700XClinical Social Worker0904020629VA

General Provider Information

NPI Number : 1104555994
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN VINSON EDD, LCSW-QS
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 : 06/20/2026

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