Provider Demographics
NPI:1700391554
Name:KRENZELOK, STEPHANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KRENZELOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W FEE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4476
Mailing Address - Country:US
Mailing Address - Phone:321-951-3949
Mailing Address - Fax:321-951-3987
Practice Address - Street 1:21 W FEE AVE STE G
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4476
Practice Address - Country:US
Practice Address - Phone:321-794-7619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW143301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical