Provider Demographics
NPI:1386132900
Name:WORCZAK, STEPHANIE (MS)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:WORCZAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-2025
Mailing Address - Country:US
Mailing Address - Phone:434-987-2667
Mailing Address - Fax:
Practice Address - Street 1:401 MCINTIRE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4579
Practice Address - Country:US
Practice Address - Phone:434-987-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000585103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool