Provider Demographics
NPI:1568188639
Name:FANFONI, STEFANO (LMFT, PHD CANDIDATE)
Entity Type:Individual
Prefix:
First Name:STEFANO
Middle Name:
Last Name:FANFONI
Suffix:
Gender:M
Credentials:LMFT, PHD CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 E LAS OLAS BLVD STE 202B
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2376
Mailing Address - Country:US
Mailing Address - Phone:973-873-4445
Mailing Address - Fax:
Practice Address - Street 1:1263 E LAS OLAS BLVD STE 202B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2376
Practice Address - Country:US
Practice Address - Phone:973-873-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist