Healthcare Provider Details

I. General information

NPI: 1205505575
Provider Name (Legal Business Name): ANNA STEPHENSON LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DUTCH ST APT 53C
NEW YORK NY
10038-0169
US

IV. Provider business mailing address

19 DUTCH ST APT 53C
NEW YORK NY
10038-0169
US

V. Phone/Fax

Practice location:
  • Phone: 770-547-3287
  • Fax:
Mailing address:
  • Phone: 770-547-3287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number002595
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: