Provider Demographics
NPI:1447341789
Name:VANSCHOYCK, STEPHEN R (PHD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:VANSCHOYCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 W MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2149
Mailing Address - Country:US
Mailing Address - Phone:215-752-7111
Mailing Address - Fax:215-752-3504
Practice Address - Street 1:148 W MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2149
Practice Address - Country:US
Practice Address - Phone:215-752-7111
Practice Address - Fax:215-752-3504
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004278L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA071015Medicare ID - Type Unspecified
R05909Medicare UPIN