Healthcare Provider Details

I. General information

NPI: 1063872471
Provider Name (Legal Business Name): STELLA THOMAS MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MANHATTAN AVE
BROOKLYN NY
11206-3950
US

IV. Provider business mailing address

681 CLARKSON AVE
BROOKLYN NY
11203-2125
US

V. Phone/Fax

Practice location:
  • Phone: 718-388-3075
  • Fax: 718-388-4468
Mailing address:
  • Phone: 718-388-3075
  • Fax: 718-388-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: