Provider Demographics
NPI:1598872012
Name:DEVECCHIS, STEPHEN P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:DEVECCHIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 INDUSTRIAL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1700
Mailing Address - Country:US
Mailing Address - Phone:814-935-5578
Mailing Address - Fax:814-695-4648
Practice Address - Street 1:2817 INDUSTRIAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1700
Practice Address - Country:US
Practice Address - Phone:814-935-5578
Practice Address - Fax:814-695-4648
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0147731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA082392Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER