Healthcare Provider Details

I. General information

NPI: 1710661582
Provider Name (Legal Business Name): STEPHANIE JOSEPH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

1645 E 53RD ST
BROOKLYN NY
11234-3915
US

V. Phone/Fax

Practice location:
  • Phone: 929-505-3844
  • Fax:
Mailing address:
  • Phone: 347-822-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number027737
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number027737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: