Provider Demographics
NPI:1407016272
Name:HENRY, STEPHANIE S (LCSW, CAP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:S
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:SERENITY THERAPEUTIC
Other - Middle Name:SERVICES OF SOUTH
Other - Last Name:FLORIDA, INC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:INCORPORATION
Mailing Address - Street 1:8358 W. OAKLAND PARK BLVD.
Mailing Address - Street 2:SUITE 202K
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351
Mailing Address - Country:US
Mailing Address - Phone:954-298-7859
Mailing Address - Fax:
Practice Address - Street 1:8358 W. OAKLAND PARK BLVD.
Practice Address - Street 2:SUITE 202K
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-298-7859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 4220101YA0400X
FLSW90011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)