Provider Demographics
NPI:1265842983
Name:STRAETER, STEPHANIE VERONICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:VERONICA
Last Name:STRAETER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 PALM AVE
Mailing Address - Street 2:B-402
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5992
Mailing Address - Country:US
Mailing Address - Phone:619-549-1456
Mailing Address - Fax:
Practice Address - Street 1:275 PALM AVE
Practice Address - Street 2:B-402
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5992
Practice Address - Country:US
Practice Address - Phone:619-549-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19872103TC0700X
FLPY8570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical