Stephanie Edworthy

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-23-264909 Issued in FL

Practice address

11808 N Ohio St
Dunnellon, FL 34431-6724

Phone

(352) 462-7021

Fax

(352) 245-0766

NPI assigned

Mar 31, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Practical Behavior Solutions, LLC

  • Behavior Analyst
  • Dunnellon, FL
  • NPI 1043899396

  Single Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1649975640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11808 N OHIO ST",
            "city": "DUNNELLON",
            "state": "FL",
            "postal_code": "344316724",
            "telephone_number": "352-462-7021",
            "fax_number": "352-245-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11808 N OHIO ST",
            "city": "DUNNELLON",
            "state": "FL",
            "postal_code": "344316724",
            "telephone_number": "352-462-7021",
            "fax_number": "352-245-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWORTHY",
        "first_name": "STEPHANIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-31",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-23-264909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dunnellon Eye Care LLC
• Dunnellon Podiatry Center P a
• Dunnellon Taxi and Car Service LLC
• Ronnie Lee Durrance, LMT
• Lisa Dutkiewicz, LMT
• Kaitlyn Marie Eichler, APRN
• Adrienne Ellers, BCBA
• David Ellers
• Mary Ann Ellis, ED.S.
• Samantha Ellis, RBT

• All providers in Dunnellon, FL
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.