Provider Demographics
NPI:1053929927
Name:BABCOCK, STEPHANIE SHIRLEY (LMSW, IMH-E)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SHIRLEY
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:LMSW, IMH-E
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:SHIRLEY
Other - Last Name:PAETZKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:6430 LOZON RD
Mailing Address - Street 2:
Mailing Address - City:COTTRELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3109
Mailing Address - Country:US
Mailing Address - Phone:586-859-8349
Mailing Address - Fax:
Practice Address - Street 1:31205 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1848
Practice Address - Country:US
Practice Address - Phone:586-213-1850
Practice Address - Fax:586-846-4354
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010971061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14923053OtherCAQH