Provider Demographics
NPI:1073759908
Name:KEGEL, STEPHANIE NOVOTNY (LCSW CAADC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NOVOTNY
Last Name:KEGEL
Suffix:
Gender:F
Credentials:LCSW CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 W MILLPORT RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9324
Mailing Address - Country:US
Mailing Address - Phone:717-625-3083
Mailing Address - Fax:717-625-3073
Practice Address - Street 1:2421 WILLOW STREET PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602
Practice Address - Country:US
Practice Address - Phone:717-464-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4504101YA0400X
PASW126453104100000X
PACW0169341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical