Provider Demographics
NPI:1407671746
Name:BALLAN, STEFANY ANDREINA
Entity type:Individual
Prefix:
First Name:STEFANY
Middle Name:ANDREINA
Last Name:BALLAN
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 1:3003 MARTA CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0742
Mailing Address - Country:US
Mailing Address - Phone:407-954-9546
Mailing Address - Fax:
Practice Address - Street 1:3003 MARTA CIR APT 203
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0742
Practice Address - Country:US
Practice Address - Phone:407-954-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor