Healthcare Provider Details

I. General information

NPI: 1174793194
Provider Name (Legal Business Name): ALEXANDER GABRIEL STEFANINI LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MS. ANGELINA NICOLE STEFANINI

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 RUSSELL ROAD
PAOLI PA
19301
US

IV. Provider business mailing address

680 AMERICA AVE SUITE 302
KING OF PRUSSIA PA
19406
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6464
  • Fax:
Mailing address:
  • Phone: 610-644-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5511
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: