Provider Demographics
NPI:1922396415
Name:GARBACZ, STANLEY ANDREW (PLP)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:ANDREW
Last Name:GARBACZ
Suffix:
Gender:M
Credentials:PLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3727
Mailing Address - Country:US
Mailing Address - Phone:402-559-8943
Mailing Address - Fax:402-559-5737
Practice Address - Street 1:444 S 44TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3727
Practice Address - Country:US
Practice Address - Phone:402-559-8943
Practice Address - Fax:402-559-5737
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE409103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025287200Medicaid