Provider Demographics
NPI:1942579412
Name:FREEMAN, STEPHANIE MICHELLE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MICHELLE
Other - Last Name:MAURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2138 SANDRIDGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726
Mailing Address - Country:US
Mailing Address - Phone:502-741-7660
Mailing Address - Fax:
Practice Address - Street 1:2138 SANDRIDGE CIR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4486
Practice Address - Country:US
Practice Address - Phone:502-741-7660
Practice Address - Fax:844-352-7745
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-09-5904103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017606000Medicaid