Provider Demographics
NPI:1730965674
Name:DIBBLE, STEPHANIE CAROLYN (MFT-INTERN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CAROLYN
Last Name:DIBBLE
Suffix:
Gender:F
Credentials:MFT-INTERN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:CAROLYN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT-INTERN
Mailing Address - Street 1:138 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163-7714
Mailing Address - Country:US
Mailing Address - Phone:315-366-2327
Mailing Address - Fax:
Practice Address - Street 1:138 N COURT ST
Practice Address - Street 2:
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163-7714
Practice Address - Country:US
Practice Address - Phone:315-366-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program