Provider Demographics
NPI:1669502209
Name:WEEKS, STEFAN MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:MICHAEL
Last Name:WEEKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SLEDDING PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5590
Mailing Address - Country:US
Mailing Address - Phone:386-793-3955
Mailing Address - Fax:
Practice Address - Street 1:400 N STATE ROAD 19 STE 48
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2449
Practice Address - Country:US
Practice Address - Phone:386-329-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW76231041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075795100Medicaid