Provider Demographics
NPI:1922082023
Name:STEPHANY, CARLA (MSSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:STEPHANY
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-9054
Mailing Address - Country:US
Mailing Address - Phone:920-933-7807
Mailing Address - Fax:
Practice Address - Street 1:5445 MARK DABLING BLVD
Practice Address - Street 2:STE 105
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3800
Practice Address - Country:US
Practice Address - Phone:719-822-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7312-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical