MEDICARE: STEPHANIE CONNEL

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	106H00000X	Marriage & Family Therapist	MT3180	FL

General Provider Information

NPI Number	:	1689087561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CONNEL

Provider Business Mailing Address
First Line	:	10823 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-8012
Country	:	US
Telephone Number	:	813-391-3495
Fax Number	:

Provider Business Practice Location Address
First Line	:	10823 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-8012
Country	:	US
Telephone Number	:	813-391-3495
Fax Number	:

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	01/09/2024

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Directions to “ STEPHANIE CONNEL ” Practice Location

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