Provider Demographics
NPI:1508310202
Name:CLEVELAND, STEPHANIE AYN (MSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:AYN
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:AYN
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1308 VERANDA WAY
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-1248
Mailing Address - Country:US
Mailing Address - Phone:772-360-8762
Mailing Address - Fax:
Practice Address - Street 1:1308 VERANDA WAY
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1248
Practice Address - Country:US
Practice Address - Phone:772-360-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker