Provider Demographics
NPI:1427550607
Name:MITCHELL, STEPFANIE NICOLE (BCBA)
Entity type:Individual
Prefix:
First Name:STEPFANIE
Middle Name:NICOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:STEPFANIE
Other - Middle Name:NICOLE
Other - Last Name:CLAUDIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6560 NW CHUGWATER CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2305
Mailing Address - Country:US
Mailing Address - Phone:561-214-1518
Mailing Address - Fax:
Practice Address - Street 1:6560 NW CHUGWATER CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2305
Practice Address - Country:US
Practice Address - Phone:561-214-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty