Provider Demographics
NPI:1699049916
Name:RENFROW-SANTISO, STEPHANIE L (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:RENFROW-SANTISO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W CAMINO REAL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:919-272-3618
Mailing Address - Fax:561-952-6922
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 302
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:919-272-3618
Practice Address - Fax:561-952-6922
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist