Provider Demographics
NPI:1780633578
Name:ROSENFELD, STACEY M (PHD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:M
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 SALZEDO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6725
Mailing Address - Country:US
Mailing Address - Phone:305-846-9370
Mailing Address - Fax:
Practice Address - Street 1:4601 PONCE DE LEON BLVD
Practice Address - Street 2:260
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2111
Practice Address - Country:US
Practice Address - Phone:917-847-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016505103TC0700X
CAPSY 24209103TC0700X
FLPY 9153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical