Provider Demographics
NPI:1043504905
Name:DELACRUZ, STEPHANIE MAXINE (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MAXINE
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8895 N MILITARY TRAIL, STE 300C
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6279
Mailing Address - Country:US
Mailing Address - Phone:561-244-9499
Mailing Address - Fax:561-345-3800
Practice Address - Street 1:5205 GREENWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2400
Practice Address - Country:US
Practice Address - Phone:561-244-9499
Practice Address - Fax:561-345-3800
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014647600Medicaid
FL0143504905Medicaid