Provider Demographics
NPI:1295623890
Name:STAZZONE, BETHANY ANN I (RMFT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:STAZZONE
Suffix:I
Gender:F
Credentials:RMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 GRAY DOVE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1390
Mailing Address - Country:US
Mailing Address - Phone:732-703-0381
Mailing Address - Fax:
Practice Address - Street 1:430 SUMMERHAVEN DR
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2755
Practice Address - Country:US
Practice Address - Phone:732-703-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4394101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor