Healthcare Provider Details

I. General information

NPI: 1164689246
Provider Name (Legal Business Name): STEVEN LOUIS DEMBY PH,D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2008
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 HENRY ST
BROOKLYN NY
11231-3011
US

IV. Provider business mailing address

465 HENRY ST
BROOKLYN NY
11231-3011
US

V. Phone/Fax

Practice location:
  • Phone: 718-797-2683
  • Fax: 718-797-2683
Mailing address:
  • Phone: 718-797-2683
  • Fax: 718-797-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number006585
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number006585
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number006585
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: