Provider Demographics
NPI:1588728729
Name:STRZELECKI, STEPHEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:STRZELECKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S SHARON AMITY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2898
Mailing Address - Country:US
Mailing Address - Phone:704-644-0946
Mailing Address - Fax:704-644-8381
Practice Address - Street 1:319 S SHARON AMITY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2898
Practice Address - Country:US
Practice Address - Phone:704-644-0946
Practice Address - Fax:704-644-8381
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2155103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000063Medicaid