Provider Demographics
NPI:1093017501
Name:RASBACH, STEPHANIE ANN (MA MS BCBA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:RASBACH
Suffix:
Gender:F
Credentials:MA MS BCBA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 E EAU GALLIE BLVD # 230
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4874
Mailing Address - Country:US
Mailing Address - Phone:407-421-9993
Mailing Address - Fax:
Practice Address - Street 1:225 S SWOOPE AVE STE 211
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5786
Practice Address - Country:US
Practice Address - Phone:407-622-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7662103K00000X
FLMH20409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst