Provider Demographics
NPI:1619149002
Name:CREEDON, STEPHANIE DIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DIANE
Last Name:CREEDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13591 CALOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BCH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418
Mailing Address - Country:US
Mailing Address - Phone:561-694-0622
Mailing Address - Fax:561-624-9720
Practice Address - Street 1:3378 FOREST HILL BLVD
Practice Address - Street 2:STE A-203 PALM BCH COUNTY SCHOOL DISTRICT
Practice Address - City:PALM BCH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:561-379-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6156103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist