Healthcare Provider Details

I. General information

NPI: 1730395351
Provider Name (Legal Business Name): STEPHANIE ELAINE LOMAX LCSW-R, CASAC, SAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 MACDOUGAL ST
BROOKLYN NY
11233-5924
US

IV. Provider business mailing address

16433 109TH RD
JAMAICA NY
11433-2915
US

V. Phone/Fax

Practice location:
  • Phone: 929-712-5738
  • Fax: 212-470-9118
Mailing address:
  • Phone: 929-712-5738
  • Fax: 212-470-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114148
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR054349
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6130
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: