Healthcare Provider Details

I. General information

NPI: 1790955698
Provider Name (Legal Business Name): STEFANIE CZERNIEWSKI CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 OAKLEY ST
POUGHKEEPSIE NY
12601-2005
US

IV. Provider business mailing address

339 HOLLOW RD
STAATSBURG NY
12580-5749
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-3570
  • Fax: 845-486-3599
Mailing address:
  • Phone: 845-889-4287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00041-135
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: