Provider Demographics
NPI:1952008344
Name:KLEIN, STEPHANIE MICHELLE-WORMAN
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MICHELLE-WORMAN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6694 SWEET MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1940
Mailing Address - Country:US
Mailing Address - Phone:561-699-2661
Mailing Address - Fax:561-699-2661
Practice Address - Street 1:6694 SWEET MAPLE LN
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-1940
Practice Address - Country:US
Practice Address - Phone:561-699-2661
Practice Address - Fax:561-699-2661
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician