Provider Demographics
NPI:1215021860
Name:MORENO, STEPHANIE OWEN (LMFT, ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:OWEN
Last Name:MORENO
Suffix:
Gender:F
Credentials:LMFT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 NW 10 ST.
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-2342
Mailing Address - Country:US
Mailing Address - Phone:954-920-0391
Mailing Address - Fax:
Practice Address - Street 1:2231 N. UNIVERSITY DR.
Practice Address - Street 2:SUITE C
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-989-8818
Practice Address - Fax:954-989-8812
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist