Provider Demographics
NPI:1023634490
Name:STAVROPOULOS, STEPHANIE CLORINDA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CLORINDA
Last Name:STAVROPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 EASTON PL
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-5610
Mailing Address - Country:US
Mailing Address - Phone:630-806-6767
Mailing Address - Fax:
Practice Address - Street 1:3103 EASTON PL
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-5610
Practice Address - Country:US
Practice Address - Phone:630-806-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0092551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical