Provider Demographics
NPI:1427087550
Name:GANSERT, STEPHANIE (PSYD)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:GANSERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 SW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-3631
Mailing Address - Country:US
Mailing Address - Phone:954-540-4960
Mailing Address - Fax:
Practice Address - Street 1:15127 JOG RD
Practice Address - Street 2:SUITE 106
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1251
Practice Address - Country:US
Practice Address - Phone:561-495-6300
Practice Address - Fax:561-495-8877
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6817103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY6817OtherSTATE LICENSE FL
FLPY6817OtherSTATE LICENSE FL