Provider Demographics
NPI:1053721712
Name:STEPANOVA, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:STEPANOVA
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 1:5442 OLD ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-7934
Mailing Address - Country:US
Mailing Address - Phone:610-301-2858
Mailing Address - Fax:
Practice Address - Street 1:5442 OLD ROUTE 22
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-7934
Practice Address - Country:US
Practice Address - Phone:610-301-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001860101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor