Provider Demographics
NPI:1669744348
Name:MASZAK, STEPHANIE (LCSW, CADC, CCTP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MASZAK
Suffix:
Gender:F
Credentials:LCSW, CADC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 N BRIDGE ST
Mailing Address - Street 2:STE D
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-2156
Mailing Address - Country:US
Mailing Address - Phone:331-216-3363
Mailing Address - Fax:
Practice Address - Street 1:803 N BRIDGE ST STE D
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-2156
Practice Address - Country:US
Practice Address - Phone:331-216-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30066101YA0400X
IL14901751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)