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NPI Code Detail

MEDICARE: ALICE A. STEPHENS L.C.S.W.

MEDICARE: ALICE A. STEPHENS L.C.S.W.
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
1101Y00000XCounselorSW4388FL
21041C0700XClinical Social WorkerSW4388FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Z028JOTHERFLBC/BS
2189743OTHERFLWELLCARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285600551
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICE A. STEPHENS L.C.S.W.
Provider Business Mailing Address
First Line : 330 KAY LARKIN DR
Second Line :
City : PALATKA
State : FL
Zip : 32177-2307
Country : US
Telephone Number : 386-329-3780
Fax Number : 386-329-3786
Provider Business Practice Location Address
First Line : 330 KAY LARKIN DR
Second Line :
City : PALATKA
State : FL
Zip : 32177-2307
Country : US
Telephone Number : 386-329-3780
Fax Number : 386-329-3786
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 06/17/2008

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