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NPI Code Detail

MEDICARE: STACY KENTRUS

MEDICARE: STACY KENTRUS
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609222009
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY KENTRUS
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number : 855-832-6727
Fax Number :
Provider Business Practice Location Address
First Line : 9160 FORUM CORPORATE PKWY STE 350
Second Line :
City : FORT MYERS
State : FL
Zip : 33905-7808
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2016
Last Update Date : 09/12/2025

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1144632191 — REBECCA BIALY
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1518354984 — DR. MATTHEW THOMAS DINER PHD
Practice Location Address:
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1336691146 — MRS. LAUREN MARJORIE LATHAM BCBA
Practice Location Address:
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Directions to “ STACY KENTRUS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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