Healthcare Provider Details

I. General information

NPI: 1164037131
Provider Name (Legal Business Name): ANDREA STOPA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TILDEN ST
BRONX NY
10467-6013
US

IV. Provider business mailing address

2710 NEWTOWN AVE APT 6G
ASTORIA NY
11102-2460
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-3400
  • Fax:
Mailing address:
  • Phone: 845-239-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: