Provider Demographics
NPI:1558372037
Name:MEARS, STEPHANIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:MEARS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 WOODGATE BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5881
Mailing Address - Country:US
Mailing Address - Phone:352-394-5922
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:655 W HIGHWAY 50
Practice Address - Street 2:SUITE 104
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2982
Practice Address - Country:US
Practice Address - Phone:352-394-5922
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 83561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8364ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER