Healthcare Provider Details

I. General information

NPI: 1003169574
Provider Name (Legal Business Name): TRICIA STEPHENS LCSW-R PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 5TH AVE SUITE 900
NEW YORK NY
10011-4306
US

IV. Provider business mailing address

306 GOLD ST 29C
BROOKLYN NY
11201-3014
US

V. Phone/Fax

Practice location:
  • Phone: 212-947-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberR074923
License Number StateNY

VIII. Authorized Official

Name: MS. TRICIA STEPHENS
Title or Position: PRESIDENT
Credential: LCSW-R
Phone: 347-693-5284