Provider Demographics
NPI:1043926058
Name:MARAVELAS, STEVEN MICHAEL
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:MARAVELAS
Suffix:
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 1:12070 43RD ST NE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-8427
Mailing Address - Country:US
Mailing Address - Phone:763-515-3150
Mailing Address - Fax:763-595-1036
Practice Address - Street 1:12070 43RD ST NE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-8427
Practice Address - Country:US
Practice Address - Phone:763-515-3150
Practice Address - Fax:763-595-1036
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician