Provider Demographics
NPI:1912028895
Name:STEPANSKI, EDWARD J (PHD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:STEPANSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 CARTERS VIEW LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5360
Mailing Address - Country:US
Mailing Address - Phone:901-277-7158
Mailing Address - Fax:
Practice Address - Street 1:1770 KIRBY PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-7401
Practice Address - Country:US
Practice Address - Phone:901-435-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2712103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical