Healthcare Provider Details

I. General information

NPI: 1104995018
Provider Name (Legal Business Name): THOMAS CHRISTOPHER STEPHENS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 DELAWARE AVENUE DELAWARE EXECUTIVE OFFICE SUITES, SUITE 11
OLEAN NY
14760
US

IV. Provider business mailing address

237 DELAWARE AVENUE DELAWARE EXECUTIVE OFFICE SUITES, SUITE 11
OLEAN NY
14760
US

V. Phone/Fax

Practice location:
  • Phone: 716-378-7210
  • Fax:
Mailing address:
  • Phone: 716-378-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR0415881
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR0415881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: