Provider Demographics
NPI:1962821884
Name:AVINGER, STEPHANIE D (LCSW-C, LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:AVINGER
Suffix:
Gender:F
Credentials:LCSW-C, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 TROPEA WAY UNIT 1431
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8885
Mailing Address - Country:US
Mailing Address - Phone:267-235-4263
Mailing Address - Fax:
Practice Address - Street 1:466 TOWN PLAZA AVE STE 310
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5185
Practice Address - Country:US
Practice Address - Phone:443-581-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490273361041C0700X
FLSW231321041C0700X
MD196061041C0700X
DCLC500829461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBK70-0000OtherCAREFIRST BCBS
MD079653100Medicaid