1376880872 NPI number — STANLEY CARL ZDANCEWICZ LCSW C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376880872 NPI number — STANLEY CARL ZDANCEWICZ LCSW C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZDANCEWICZ
Provider First Name:
STANLEY
Provider Middle Name:
CARL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1376880872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 ROLLING CROSSROADS
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-719-0086
Provider Business Mailing Address Fax Number:
443-341-6218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 W. ROLLING CROSSROADS
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-562-4254
Provider Business Practice Location Address Fax Number:
443-341-6218
Provider Enumeration Date:
01/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  18524 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251B00000X , with the licence number: 18524 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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