Provider Demographics
NPI:1518108737
Name:BUBECK, STEPHANIE A (LPC)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:A
Last Name:BUBECK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-1428
Mailing Address - Country:US
Mailing Address - Phone:724-962-1626
Mailing Address - Fax:
Practice Address - Street 1:272 E CONNELLY BLVD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-1852
Practice Address - Country:US
Practice Address - Phone:724-983-1131
Practice Address - Fax:724-983-1387
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional