Provider Demographics
NPI:1033917729
Name:DENSBERGER, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:DENSBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 TWIN OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7328
Mailing Address - Country:US
Mailing Address - Phone:407-415-7269
Mailing Address - Fax:
Practice Address - Street 1:1850 LEE RD STE 230
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2106
Practice Address - Country:US
Practice Address - Phone:407-789-0821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS-1777103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool