1790282192 NPI number — STEFAN C. DOMBROWSKI, PH.D. & ASSOCIATES, LLC

Table of content: (NPI 1790282192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790282192 NPI number — STEFAN C. DOMBROWSKI, PH.D. & ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEFAN C. DOMBROWSKI, PH.D. & ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
POTENTIALITY COUNSELING & PSYCHOTHERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790282192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 ROBERTS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-745-6291
Provider Business Mailing Address Fax Number:
856-424-7553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3804 CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-745-6291
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DOMBROWSKI
Authorized Official First Name:
STEFAN
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
856-745-6291

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 35SI00420600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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