Provider Demographics
NPI:1841707403
Name:DEGRATE, STEPHANIE S (LCSW-S)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:S
Last Name:DEGRATE
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:S
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:11816 INWOOD RD # 1464
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-8011
Mailing Address - Country:US
Mailing Address - Phone:469-845-8983
Mailing Address - Fax:214-367-6176
Practice Address - Street 1:11816 INWOOD RD # 1464
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-8011
Practice Address - Country:US
Practice Address - Phone:469-845-8983
Practice Address - Fax:214-367-6176
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX555161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX55516OtherLICENSE