MEDICARE: STEPHANIE ELIZABETH RASEL LCSW, BCBA, ITDS

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	103K00000X	Behavior Analyst	1-15-19401
2	222Q00000X	Developmental Therapist
3	1041C0700X	Clinical Social Worker	SW15593	FL

General Provider Information

NPI Number	:	1831545250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ELIZABETH RASEL LCSW, BCBA, ITDS

Provider Business Mailing Address
First Line	:	2029 OKEECHOBEE BLVD # 1145
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4131
Country	:	US
Telephone Number	:	561-325-6468
Fax Number	:

Provider Business Practice Location Address
First Line	:	2029 OKEECHOBEE BLVD # 1145
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4131
Country	:	US
Telephone Number	:	561-325-6468
Fax Number	:

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

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	06/27/2022

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