Healthcare Provider Details

I. General information

NPI: 1194418087
Provider Name (Legal Business Name): STEPHANIE LUCIA GUTKIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 82ND ST # LLP101
NEW YORK NY
10024-5511
US

IV. Provider business mailing address

107 W 82ND ST # LLP101
NEW YORK NY
10024-5511
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-4112
  • Fax:
Mailing address:
  • Phone: 646-389-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: