=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487198123
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE ORDONEZ MHC, CASAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2016
-----------------------------------------------------
Last Update Date | 02/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 872 MIDDLE COUNTRY RD
-----------------------------------------------------
City | SAINT JAMES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11780-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-758-8290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 WOODBINE ST
-----------------------------------------------------
City | CORAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11727-1140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-754-0517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 32623
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | P112967
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------