Provider Demographics
NPI:1811458532
Name:KURTYKA, STEPHANIE (LCPAT, LCPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KURTYKA
Suffix:
Gender:F
Credentials:LCPAT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17915 LYLES DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-9612
Mailing Address - Country:US
Mailing Address - Phone:301-988-7151
Mailing Address - Fax:
Practice Address - Street 1:1707 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4135
Practice Address - Country:US
Practice Address - Phone:240-285-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC230221700000X
MDLC9422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist