Provider Demographics
NPI:1457746943
Name:DEFINO, STEPHEN J (LCPC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:DEFINO
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 ROUTE 108
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1990
Mailing Address - Country:US
Mailing Address - Phone:410-740-1901
Mailing Address - Fax:410-740-8237
Practice Address - Street 1:9030 ROUTE 108
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1990
Practice Address - Country:US
Practice Address - Phone:410-740-1901
Practice Address - Fax:410-740-8237
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health