Provider Demographics
NPI:1174793194
Name:STEFANINI, ALEXANDER GABRIEL (LPC)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:GABRIEL
Last Name:STEFANINI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MS
Other - First Name:ANGELINA
Other - Middle Name:NICOLE
Other - Last Name:STEFANINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:680 AMERICA AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406
Mailing Address - Country:US
Mailing Address - Phone:610-644-6464
Mailing Address - Fax:
Practice Address - Street 1:1440 RUSSELL ROAD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5511101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health