Healthcare Provider Details

I. General information

NPI: 1255255204
Provider Name (Legal Business Name): STIVENSON JEAN-LOUIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7 W 30TH ST FL 9
NEW YORK NY
10001-4406
US

IV. Provider business mailing address

7 W 30TH ST FL 9
NEW YORK NY
10001-4406
US

V. Phone/Fax

Practice location:
  • Phone: 212-967-4919
  • Fax: 212-967-4919
Mailing address:
  • Phone: 212-967-4919
  • Fax: 212-967-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: