Provider Demographics
NPI:1336423789
Name:MOLDAWSKY, STEPHANIE J (MA, PC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:J
Last Name:MOLDAWSKY
Suffix:
Gender:F
Credentials:MA, PC
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Other - First Name:
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Mailing Address - Street 1:6600 SYLVANIA AVE
Mailing Address - Street 2:SUITE 264
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3933
Mailing Address - Country:US
Mailing Address - Phone:419-517-4088
Mailing Address - Fax:419-517-4089
Practice Address - Street 1:6600 SYLVANIA AVE
Practice Address - Street 2:SUITE 264
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3933
Practice Address - Country:US
Practice Address - Phone:419-517-4088
Practice Address - Fax:419-517-4089
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHC. 0900595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health