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General NPI Number Information
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NPI Number | 1417271941
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Entity Type | Organization
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Legal Business Name | STUYVESANT BEHAVIORAL HEALTH COMMUNITY NETWORK
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 177 CADILLAC PL
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City | RENO
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State | NV
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Zip | 89509-4355
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Country | US
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Telephone | 775-827-7500
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Fax | 775-827-7504
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Provider Business Mailing Address
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Address Line | 177 CADILLAC PL
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City | RENO
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State | NV
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Zip | 89509-4355
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Country | US
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Telephone | 775-827-7500
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Fax | 775-827-7504
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Authorized Official
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Title or Position | COO
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Name | ROBERT PAUL STUYVESANT
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Credential |
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Telephone | 775-827-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 00137-C
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License Number State | NV
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