Provider Demographics
NPI:1437938453
Name:MINZAK, STEPHANIE J
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:MINZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6538 BEECHWOOD DR # A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1049
Mailing Address - Country:US
Mailing Address - Phone:443-214-9091
Mailing Address - Fax:
Practice Address - Street 1:7500 GREENWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:240-837-4945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician