Provider Demographics
NPI:1396123154
Name:STEDNICK, DEBORAH
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:STEDNICK
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 1:609 IVA LN
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-3805
Mailing Address - Country:US
Mailing Address - Phone:215-943-1840
Mailing Address - Fax:215-943-1840
Practice Address - Street 1:333 N OXFORD VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-2624
Practice Address - Country:US
Practice Address - Phone:215-547-5774
Practice Address - Fax:215-547-0768
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional