Provider Demographics
NPI:1447968342
Name:GOOSSENS ALAYON, STEPHANIE J (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:GOOSSENS ALAYON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 ROYAL PALM BEACH BLVD # 128
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1641
Mailing Address - Country:US
Mailing Address - Phone:561-440-7678
Mailing Address - Fax:561-440-7678
Practice Address - Street 1:1127 ROYAL PALM BEACH BLVD # 128
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1641
Practice Address - Country:US
Practice Address - Phone:561-440-7678
Practice Address - Fax:561-440-7678
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW206001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116125900Medicaid