MEDICARE: THE STEPHANOS GROUP, LLC

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	103TC0700X	Clinical Psychologist	459	NE

General Provider Information

NPI Number	:	1104976786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE STEPHANOS GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 540201
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-0201
Country	:	US
Telephone Number	:	402-650-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	15555 W DODGE RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2070
Country	:	US
Telephone Number	:	402-650-3100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEBORAH HOFFMAN
Credential	:	PSYD
Telephone Number	:	402-650-3100

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	01/30/2012

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Directions to “THE STEPHANOS GROUP, LLC ” Practice Location

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