Provider Demographics
NPI:1265924799
Name:SATTAR, STEPHANIE LAUREN (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAUREN
Last Name:SATTAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 BALLYGAR DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2435
Mailing Address - Country:US
Mailing Address - Phone:954-309-5187
Mailing Address - Fax:
Practice Address - Street 1:4917 BALLYGAR DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2435
Practice Address - Country:US
Practice Address - Phone:954-309-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW132231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical