Provider Demographics
NPI:1972767432
Name:SCHECKNER, STACEY BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BETH
Last Name:SCHECKNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W DE LEON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2731
Mailing Address - Country:US
Mailing Address - Phone:813-362-3936
Mailing Address - Fax:
Practice Address - Street 1:806 W DE LEON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2731
Practice Address - Country:US
Practice Address - Phone:813-362-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7217103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY7217OtherPSYCHOLOGIST