Provider Demographics
NPI:1568907046
Name:DRONGOSKI, STACEY LYNN (BS, RBT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:DRONGOSKI
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1327
Mailing Address - Country:US
Mailing Address - Phone:570-352-2196
Mailing Address - Fax:
Practice Address - Street 1:1373 OVERLEA DR
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4748
Practice Address - Country:US
Practice Address - Phone:570-352-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-24726106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician