Provider Demographics
NPI:1992489678
Name:HAUPTFLEISCH, STEPHAN (LP)
Entity type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:HAUPTFLEISCH
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 FRUITVILLE RD STE 139
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5367
Mailing Address - Country:US
Mailing Address - Phone:941-977-5444
Mailing Address - Fax:
Practice Address - Street 1:2803 FRUITVILLE RD STE 139
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5367
Practice Address - Country:US
Practice Address - Phone:941-977-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11651103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty