Healthcare Provider Details

I. General information

NPI: 1447985155
Provider Name (Legal Business Name): MAXIMILIAN MARTIN STEPANIAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date: 02/03/2023
Reactivation Date: 02/28/2023

III. Provider practice location address

5050 MADISON RD
CINCINNATI OH
45227-1491
US

IV. Provider business mailing address

PO BOX 396
SPRINGBORO OH
45066-0396
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-2800
  • Fax: 513-272-2807
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: