Provider Demographics
NPI:1902155112
Name:STEPHANSKY, JEANEEN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JEANEEN
Middle Name:
Last Name:STEPHANSKY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W BRUNSWICK DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9187
Mailing Address - Country:US
Mailing Address - Phone:517-337-2972
Mailing Address - Fax:517-349-1973
Practice Address - Street 1:244 W BRUNSWICK DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9187
Practice Address - Country:US
Practice Address - Phone:517-337-2972
Practice Address - Fax:517-349-1973
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010620521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical