Provider Demographics
NPI:1659624609
Name:MILNE, STEPHANIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:MILNE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WELLS RD
Mailing Address - Street 2:STE 304
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3037
Mailing Address - Country:US
Mailing Address - Phone:904-720-4040
Mailing Address - Fax:904-720-4596
Practice Address - Street 1:165 WELLS RD
Practice Address - Street 2:STE 304
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3037
Practice Address - Country:US
Practice Address - Phone:904-720-4040
Practice Address - Fax:904-720-4596
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9283103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical