Provider Demographics
NPI:1255413001
Name:STEPHENSON, FRED DOUGLAS (MSW,LCSW, LMFT)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:DOUGLAS
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:MSW,LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 W CORPORATE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-2694
Mailing Address - Country:US
Mailing Address - Phone:352-795-7070
Mailing Address - Fax:
Practice Address - Street 1:6212 W CORPORATE OAKS DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-2694
Practice Address - Country:US
Practice Address - Phone:352-795-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical