Provider Demographics
NPI:1831545250
Name:RASEL, STEPHANIE ELIZABETH (LCSW, BCBA, ITDS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:RASEL
Suffix:
Gender:F
Credentials:LCSW, BCBA, ITDS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ELIZABETH
Other - Last Name:BENITEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, BCBA, ITDS
Mailing Address - Street 1:2029 OKEECHOBEE BLVD # 1145
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-4131
Mailing Address - Country:US
Mailing Address - Phone:561-325-6468
Mailing Address - Fax:
Practice Address - Street 1:2029 OKEECHOBEE BLVD # 1145
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4131
Practice Address - Country:US
Practice Address - Phone:561-325-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-19401103K00000X
222Q00000X
FLSW155931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist