Healthcare Provider Details

I. General information

NPI: 1396072013
Provider Name (Legal Business Name): DONNETTA STALLINGS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 3RD AVE
BRONX NY
10454-1117
US

IV. Provider business mailing address

13720 231ST ST
LAURELTON NY
11413-2831
US

V. Phone/Fax

Practice location:
  • Phone: 646-393-9680
  • Fax: 646-393-9678
Mailing address:
  • Phone: 718-978-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number098200
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: