Provider Demographics
NPI:1265659031
Name:KESTLER, STEPHANIE MARY (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARY
Last Name:KESTLER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8258 VETERANS HWY
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1457
Mailing Address - Country:US
Mailing Address - Phone:410-768-6088
Mailing Address - Fax:410-768-6444
Practice Address - Street 1:8258 VETERANS HWY
Practice Address - Street 2:SUITE 13
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1457
Practice Address - Country:US
Practice Address - Phone:410-768-6088
Practice Address - Fax:410-768-6444
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD076851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442240600Medicaid
MDM389Medicare ID - Type UnspecifiedMEDICARE #
MDPTAN240236Medicare PIN