Provider Demographics
NPI:1063653087
Name:BERENS, STEPHANIE
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:
Last Name:BERENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 TRIAD CENTER DRIVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9086
Mailing Address - Country:US
Mailing Address - Phone:336-931-1814
Mailing Address - Fax:
Practice Address - Street 1:7900 TRIAD CENTER DRIVE
Practice Address - Street 2:SUITE 350
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9086
Practice Address - Country:US
Practice Address - Phone:336-931-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KS5673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker