Doctor Name: | MS. STEFANIE ANNICCHIARICO RUPERTUS |
NPI Number: | 1942606041 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LC1112 |
Business Practice Address: | 2989 Summit Dr Ijamsville, MD - 217548802 |
Business Phone Number: | 3016418855 |
Business Fax Number: | 3016076826 |
Mailing Address: | 2989 Summit Dr, IJAMSVILLE |
State: | MD |
Postal Code: | 217548802 |
Phone Number: | 3016418855 |
Fax Number: | 3016076826 |
NPI Enumeration Date: | 11/17/2014 |
NPI Last Update Date: | 11/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LC1112 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |