Provider Demographics
NPI:1568531994
Name:KANE, STEPHANIE RACHEL (MA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RACHEL
Last Name:KANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 NE 19TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3070
Mailing Address - Country:US
Mailing Address - Phone:954-504-7756
Mailing Address - Fax:
Practice Address - Street 1:941 NE 19TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3070
Practice Address - Country:US
Practice Address - Phone:954-504-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0000004681101YS0200X
CA040086254101YS0200X
NJ37FI00168300106H00000X
CA49989106H00000X
NJ778871101YS0200X
NY474472101101YS0200X
FLMT 2912106H00000X
FL1239796101YS0200X
CALPCC 140101YP2500X
FLPMH 1195101YP2500X
NJ37PC000494500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist