Provider Demographics
NPI:1710741186
Name:DRAKE, STEPHANIE KAY
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KAY
Other - Last Name:KOPPENHAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5579 OLD EASTON RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-9716
Mailing Address - Country:US
Mailing Address - Phone:215-262-8762
Mailing Address - Fax:
Practice Address - Street 1:16 N FRANKLIN ST STE 115
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3536
Practice Address - Country:US
Practice Address - Phone:215-262-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0235761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical