Provider Demographics
NPI:1528594223
Name:HENDERSON, STEFANIE (BCBA)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4631
Mailing Address - Country:US
Mailing Address - Phone:813-957-8327
Mailing Address - Fax:813-957-8327
Practice Address - Street 1:2858 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4631
Practice Address - Country:US
Practice Address - Phone:813-957-8327
Practice Address - Fax:813-957-8327
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-39791103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst