Healthcare Provider Details

I. General information

NPI: 1811655319
Provider Name (Legal Business Name): ANDREW L STEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 BAY RIDGE PKWY APT 2F
BROOKLYN NY
11209-3345
US

IV. Provider business mailing address

40 W 13TH ST # NA
NEW YORK NY
10011-7940
US

V. Phone/Fax

Practice location:
  • Phone: 646-620-1286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW L STEIN
Title or Position: CLINICAL PSYCHOLOGIST
Credential:
Phone: 646-620-1286