Healthcare Provider Details

I. General information

NPI: 1972139038
Provider Name (Legal Business Name): STEFANIE C VUOTTO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 08/17/2022
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 ATLANTIC AVE
EAST ROCKAWAY NY
11518-1431
US

IV. Provider business mailing address

47 FORT WASHINGTON AVE APT 55
NEW YORK NY
10032-4675
US

V. Phone/Fax

Practice location:
  • Phone: 516-341-6215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number023575
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: