Provider Demographics
NPI:1720590813
Name:DIDONATO, STEPHEN (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:DIDONATO
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3536
Mailing Address - Country:US
Mailing Address - Phone:267-438-9454
Mailing Address - Fax:
Practice Address - Street 1:1 BALA AVE STE 125
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3217
Practice Address - Country:US
Practice Address - Phone:267-438-9454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional