Provider Demographics
NPI:1023090131
Name:SCIFRES, STEPHANIE L (PHD, HSPP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:SCIFRES
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 S. EAST STREET
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:CROTHERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47229-0007
Mailing Address - Country:US
Mailing Address - Phone:812-793-2570
Mailing Address - Fax:812-793-2570
Practice Address - Street 1:139 S EAST ST
Practice Address - Street 2:
Practice Address - City:CROTHERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47229-9635
Practice Address - Country:US
Practice Address - Phone:812-793-2570
Practice Address - Fax:812-793-2570
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041838A103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH203237690100OtherCARESOURCE
UT0393476OtherUNITED HEALTHCARE
OH000000381784OtherANTHEM BCBS
IN064755OtherSIHO
IL258751OtherCOMPSYCH
OH82272400OtherMAGELLAN
TXC 231810OtherUNITED AMERICAN INSURANCE
GAP00265867OtherMEDICARE RAILROAD CARRIER
IN000000381792OtherANTHEM BCBS
CT7627650OtherAETNA
IN231810AMedicare ID - Type Unspecified
IN000000381792OtherANTHEM BCBS