=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417286899
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXIS STEIN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2009
-----------------------------------------------------
Last Update Date | 01/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 E 12TH ST SUITE 604
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-255-5359
-----------------------------------------------------
Fax | 212-255-4167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 E 12TH ST SUITE 604
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-255-5359
-----------------------------------------------------
Fax | 212-255-4167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 080376
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------