Provider Demographics
NPI:1295034171
Name:PELUSO-ABBOTT, STEPHANIE A (MSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:PELUSO-ABBOTT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BEE STREET
Mailing Address - Street 2:(MENTAL HEALTH - 116)
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-5799
Mailing Address - Country:US
Mailing Address - Phone:843-789-6324
Mailing Address - Fax:843-805-5782
Practice Address - Street 1:109 BEE STREET
Practice Address - Street 2:(MENTAL HEALTH - 116)
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401
Practice Address - Country:US
Practice Address - Phone:843-789-6324
Practice Address - Fax:843-805-5782
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8446104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker