Provider Demographics
NPI:1437298809
Name:STEVENS, MARY BANE (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BANE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 TAYWOOD MDWS
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-2026
Mailing Address - Country:US
Mailing Address - Phone:941-288-3121
Mailing Address - Fax:
Practice Address - Street 1:3300 17TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-8904
Practice Address - Country:US
Practice Address - Phone:941-217-6503
Practice Address - Fax:941-960-1123
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8675101YP1600X
FLMH 8675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764731000Medicaid