Provider Demographics
NPI:1730895640
Name:STANKOWICZ, JOSEPH ALEX I
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALEX
Last Name:STANKOWICZ
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 PLEASANTDALE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4226
Mailing Address - Country:US
Mailing Address - Phone:760-929-9066
Mailing Address - Fax:
Practice Address - Street 1:1714 PLEASANTDALE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4226
Practice Address - Country:US
Practice Address - Phone:760-920-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health