Provider Demographics
NPI:1740335389
Name:DURGIN, STEPHANIE ANN (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:DURGIN
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 1:685 ROSSMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1963
Mailing Address - Country:US
Mailing Address - Phone:321-258-2351
Mailing Address - Fax:866-639-8798
Practice Address - Street 1:3040 N WICKHAM RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2369
Practice Address - Country:US
Practice Address - Phone:321-254-3042
Practice Address - Fax:321-254-4470
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW45741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical