Provider Demographics
NPI:1770749640
Name:STEPHANI, BETH E
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:E
Last Name:STEPHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15311 CURLING CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8547
Mailing Address - Country:US
Mailing Address - Phone:704-248-8922
Mailing Address - Fax:
Practice Address - Street 1:15311 CURLING CT
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8547
Practice Address - Country:US
Practice Address - Phone:704-248-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY934119991171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator