Provider Demographics
NPI:1407984313
Name:BOYD, STEPHANIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 METROPOLITAN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-3775
Mailing Address - Country:US
Mailing Address - Phone:850-201-8452
Mailing Address - Fax:850-201-8453
Practice Address - Street 1:1584 METROPOLITAN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-3775
Practice Address - Country:US
Practice Address - Phone:850-201-8452
Practice Address - Fax:850-201-8453
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ127HOtherBCBS NUMBER