Healthcare Provider Details

I. General information

NPI: 1225946403
Provider Name (Legal Business Name): STAMATINA VASSILARAS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CEDAR LN STE 3B
TEANECK NJ
07666-3441
US

IV. Provider business mailing address

435 MAIN ST APT 647
HACKENSACK NJ
07601-6048
US

V. Phone/Fax

Practice location:
  • Phone: 201-541-8600
  • Fax:
Mailing address:
  • Phone: 917-242-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: