Basic Information
Provider Information | |||||||||
NPI: | 1851520555 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOPACINSKI | ||||||||
FirstName: | STEFANIE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ED.D, DHS, MSW, LSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2500 MARYLAND RD | ||||||||
Address2: | SUITE #400 | ||||||||
City: | WILLOW GROVE | ||||||||
State: | PA | ||||||||
PostalCode: | 190901216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1003 PONDEROSA RD | ||||||||
Address2: |   | ||||||||
City: | TREVOSE | ||||||||
State: | PA | ||||||||
PostalCode: | 190534506 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2154815450 | ||||||||
FaxNumber: | 2154815435 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/02/2009 | ||||||||
LastUpdateDate: | 05/17/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW125973 | PA | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 104100000X | CW018921 | PA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.