Healthcare Provider Details

I. General information

NPI: 1174648711
Provider Name (Legal Business Name): DENISE MARIE STUMACHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 NORTH SALEM ROAD
CROSS RIVER NY
10518
US

IV. Provider business mailing address

34 BARRY AVE
RIDGEFIELD CT
06877-4425
US

V. Phone/Fax

Practice location:
  • Phone: 203-241-4885
  • Fax:
Mailing address:
  • Phone: 203-438-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069668-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005894
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: