Provider Demographics
NPI:1326162843
Name:DARENSBOURG, STACEY LYNN (BSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LYNN
Last Name:DARENSBOURG
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2094 TREVINO CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:321-243-0014
Mailing Address - Fax:
Practice Address - Street 1:2094 TREVINO CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-243-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811944900Medicaid