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General NPI Number Information
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NPI Number | 1912104803
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Entity Type | Individual
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Provider Name | MICHAEL STEFANOV PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 302 9TH ST
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City | HONESDALE
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State | PA
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Zip | 18431-2090
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Country | US
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Telephone | 570-253-6453
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Fax | 570-253-5856
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Provider Business Mailing Address
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Address Line | 302 9TH ST
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City | HONESDALE
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State | PA
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Zip | 18431-2090
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Country | US
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Telephone | 570-253-6453
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Fax | 570-253-5856
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | PS016606
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PS016606
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS016606
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | PS016606
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PS016606
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | PS016606
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License Number State | PA
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Taxonomy #7
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | PS016606
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License Number State | PA
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Taxonomy #8
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | PS016606
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License Number State | PA
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Taxonomy #9
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS016606
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License Number State | PA
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