Stefan C. Dombrowski, PH.D. & Associates, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

STEFAN C. DOMBROWSKI, PH.D. & ASSOCIATES, LLC

Practice address

3804 Church Rd
Mount Laurel, NJ 08054-1106

Phone

(856) 745-6291

NPI assigned

Apr 11, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stefan Carl Dombrowski, PH.D.NPI 1962909226

Title

Clinical Director

Phone

(856) 745-6291

Specialties & licenses 2

Addresses

Other names 1

• Potentiality Counseling & Psychotherapy Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stefan Carl Dombrowski, PH.D.

  • Clinical Psychologist
  • Mount Laurel, NJ
  • NPI 1962909226
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1790282192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 ROBERTS DR",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080031016",
            "telephone_number": "856-745-6291",
            "fax_number": "856-424-7553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3804 CHURCH RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541106",
            "telephone_number": "856-745-6291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEFAN C. DOMBROWSKI, PH.D. & ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-11",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "DOMBROWSKI",
        "authorized_official_first_name": "STEFAN",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "856-745-6291",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NJ",
            "license": "35SI00420600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Potentiality Counseling & Psychotherapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychologist in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.