Healthcare Provider Details

I. General information

NPI: 1639473242
Provider Name (Legal Business Name): STEPHANIA CAJUSTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 34TH ST
NEW YORK NY
10001-3006
US

IV. Provider business mailing address

246 E 19TH ST
BROOKLYN NY
11226-5302
US

V. Phone/Fax

Practice location:
  • Phone: 347-625-5020
  • Fax:
Mailing address:
  • Phone: 646-287-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number077741-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085431
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085431-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085431-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: