Provider Demographics
NPI:1073674735
Name:MAGRUDER, STEPHEN L (MSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:L
Last Name:MAGRUDER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 WORLD PLAZA LN
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3940
Mailing Address - Country:US
Mailing Address - Phone:239-939-3700
Mailing Address - Fax:239-939-3889
Practice Address - Street 1:12520 WORLD PLAZA LN
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3940
Practice Address - Country:US
Practice Address - Phone:239-939-3700
Practice Address - Fax:239-939-3889
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 30061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5641Medicare ID - Type Unspecified