Provider Demographics
NPI:1912666751
Name:DEEL, STEPHANIE RENE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENE
Last Name:DEEL
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6413
Mailing Address - Country:US
Mailing Address - Phone:317-201-3377
Mailing Address - Fax:
Practice Address - Street 1:10080 E US HIGHWAY 36 STE A
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8174
Practice Address - Country:US
Practice Address - Phone:317-790-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010296A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33010296AOtherOTHER