Provider Demographics
NPI:1831493253
Name:NOWACKI-BUTZEN, STEPHANIE KAYE (PSYD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAYE
Last Name:NOWACKI-BUTZEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5355
Mailing Address - Country:US
Mailing Address - Phone:434-984-0023
Mailing Address - Fax:
Practice Address - Street 1:911 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5355
Practice Address - Country:US
Practice Address - Phone:434-984-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical