Provider Demographics
NPI:1487230280
Name:PRILL, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PRILL
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 1:7529 STANDISH PL STE 355
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2733
Mailing Address - Country:US
Mailing Address - Phone:301-444-5001
Mailing Address - Fax:
Practice Address - Street 1:7529 STANDISH PL STE 355
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-2733
Practice Address - Country:US
Practice Address - Phone:301-444-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician