Provider Demographics
NPI:1699116517
Name:JONES, STACEY BOSHNICK (PHD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:BOSHNICK
Last Name:JONES
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 1:3081 SALZEDO ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6711
Mailing Address - Country:US
Mailing Address - Phone:305-761-0132
Mailing Address - Fax:
Practice Address - Street 1:3081 SALZEDO ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6711
Practice Address - Country:US
Practice Address - Phone:305-761-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-6641103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling