Provider Demographics
NPI:1568021897
Name:STEAD, MARIE PAMELA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:PAMELA
Last Name:STEAD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5659 DUNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-7677
Mailing Address - Country:US
Mailing Address - Phone:805-231-8536
Mailing Address - Fax:
Practice Address - Street 1:5659 DUNRIDGE DR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-7677
Practice Address - Country:US
Practice Address - Phone:805-231-8536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
CA113834106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist