Provider Demographics
NPI:1942550033
Name:MCSHAN, STEPHANIE ALBERTHA (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALBERTHA
Last Name:MCSHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:FL
Mailing Address - Zip Code:32768-0639
Mailing Address - Country:US
Mailing Address - Phone:321-362-4176
Mailing Address - Fax:352-360-0762
Practice Address - Street 1:2110 N DONNELLY ST STE 500
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6968
Practice Address - Country:US
Practice Address - Phone:321-362-4176
Practice Address - Fax:321-256-5176
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW12807104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker