Provider Demographics
NPI:1841712718
Name:COOK, STEFANIA (RBT)
Entity type:Individual
Prefix:MRS
First Name:STEFANIA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MISS
Other - First Name:STEFANIA
Other - Middle Name:
Other - Last Name:GIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:527 OCEAN PARK LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-5303
Mailing Address - Country:US
Mailing Address - Phone:561-543-7019
Mailing Address - Fax:407-960-3009
Practice Address - Street 1:2062 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4285
Practice Address - Country:US
Practice Address - Phone:321-305-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician