Healthcare Provider Details

I. General information

NPI: 1437427192
Provider Name (Legal Business Name): STEPHANIE COLUMBIA LCSW-R, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S COUNTRY RD STE 209
BELLPORT NY
11713-2534
US

IV. Provider business mailing address

112 S COUNTRY RD STE 209
BELLPORT NY
11713-2534
US

V. Phone/Fax

Practice location:
  • Phone: 516-526-1814
  • Fax:
Mailing address:
  • Phone: 516-526-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075920
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: