Provider Demographics
NPI:1750697769
Name:RIDEL, STEPHANIE V (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:V
Last Name:RIDEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PRO-MED LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5317
Mailing Address - Country:US
Mailing Address - Phone:317-208-7233
Mailing Address - Fax:317-581-3918
Practice Address - Street 1:703 PRO-MED LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5317
Practice Address - Country:US
Practice Address - Phone:317-208-7233
Practice Address - Fax:317-581-3918
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042413A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical