Provider Demographics
NPI:1942606066
Name:SAFOS-MORIARTY, STEPHANIE (LMHC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SAFOS-MORIARTY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15381 DURANGO CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-5008
Mailing Address - Country:US
Mailing Address - Phone:352-598-2509
Mailing Address - Fax:
Practice Address - Street 1:15381 DURANGO CIR
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-5008
Practice Address - Country:US
Practice Address - Phone:352-598-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health