Provider Demographics
NPI:1780011585
Name:STEFANOVIC, BRIAN (EDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:STEFANOVIC
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 23RD ST SE
Mailing Address - Street 2:APT. 211C
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4575
Mailing Address - Country:US
Mailing Address - Phone:202-415-0336
Mailing Address - Fax:
Practice Address - Street 1:1813 23RD ST SE
Practice Address - Street 2:APT. 211C
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4575
Practice Address - Country:US
Practice Address - Phone:202-415-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2628103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool