Provider Demographics
NPI:1336970987
Name:KURYLAK, STEPHANIE (MED)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KURYLAK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 FOXTAIL DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9666
Mailing Address - Country:US
Mailing Address - Phone:917-291-0863
Mailing Address - Fax:
Practice Address - Street 1:961 MARCON BLVD STE 312
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-9373
Practice Address - Country:US
Practice Address - Phone:610-266-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000280103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling