Provider Demographics
NPI:1952776916
Name:BARDALES, STEPHANIE (BS, MS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BARDALES
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14220 CYBER PLACE
Mailing Address - Street 2:APT #304
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-6177
Mailing Address - Country:US
Mailing Address - Phone:954-937-6020
Mailing Address - Fax:
Practice Address - Street 1:517 DELTONA BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8016
Practice Address - Country:US
Practice Address - Phone:386-259-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist