Provider Demographics
NPI:1942221304
Name:STOVIC, MARIJANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIJANA
Middle Name:
Last Name:STOVIC
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 1:720 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2741
Mailing Address - Country:US
Mailing Address - Phone:724-349-8021
Mailing Address - Fax:724-349-8261
Practice Address - Street 1:720 CHURCH ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2741
Practice Address - Country:US
Practice Address - Phone:724-349-8021
Practice Address - Fax:724-349-8261
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008676L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ29805Medicare UPIN
PA085823-J23Medicare ID - Type UnspecifiedPSYCHOLOGIST