Provider Demographics
NPI:1871873240
Name:WRIGHT, STANLEY J
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 N NOVA RD
Mailing Address - Street 2:#115
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4447
Mailing Address - Country:US
Mailing Address - Phone:386-898-5003
Mailing Address - Fax:386-675-6490
Practice Address - Street 1:533 N NOVA RD
Practice Address - Street 2:#115
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4447
Practice Address - Country:US
Practice Address - Phone:386-898-5003
Practice Address - Fax:386-675-6490
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT1555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist