Provider Demographics
NPI:1215102934
Name:VAN INGEN, STEPHANIE PAIGE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:PAIGE
Last Name:VAN INGEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANS CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16033-1261
Mailing Address - Country:US
Mailing Address - Phone:724-538-3103
Mailing Address - Fax:
Practice Address - Street 1:217 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANS CITY
Practice Address - State:PA
Practice Address - Zip Code:16033-1261
Practice Address - Country:US
Practice Address - Phone:724-538-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0156611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical