Healthcare Provider Details

I. General information

NPI: 1144213463
Provider Name (Legal Business Name): GABRIELLE STUTMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 5TH AVE SUITE 907
NEW YORK NY
10016-6601
US

IV. Provider business mailing address

116 ROUND HILL RD
DOBBS FERRY NY
10522-3305
US

V. Phone/Fax

Practice location:
  • Phone: 212-254-7390
  • Fax:
Mailing address:
  • Phone: 914-693-5045
  • Fax: 914-693-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number007131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: