Healthcare Provider Details

I. General information

NPI: 1285819805
Provider Name (Legal Business Name): SHANEE STEPAKOFF PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN A STEPAKOFF PHD

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 5TH AVE SUITE 1405
NEW YORK NY
10011-8002
US

IV. Provider business mailing address

PO BOX 212
FARMINGTON ME
04938-0212
US

V. Phone/Fax

Practice location:
  • Phone: 646-596-6792
  • Fax:
Mailing address:
  • Phone: 207-578-4483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number017212
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number017212
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS1544
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017212
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number017212
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number017212
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7651
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: