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General NPI Number Information
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NPI Number | 1184134330
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Entity Type | Individual
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Provider Name | MICHELE STANBACK
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 1 HOYT ST FL 7
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City | BROOKLYN
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State | NY
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Zip | 11201-5809
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Country | US
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Telephone | 718-802-0666
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Fax |
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Provider Business Mailing Address
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Address Line | 3660 WALDO AVE APT 8K
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City | BRONX
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State | NY
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Zip | 10463-2228
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Country | US
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Telephone | 202-258-3940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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