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General NPI Number Information
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NPI Number | 1518452226
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Entity Type | Individual
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Provider Name | CRAIG EVAN STEPHENSON
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Gender | Male
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 25 CENTRAL PARK W APT 1N
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City | NEW YORK
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State | NY
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Zip | 10023-7210
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Country | US
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Telephone | 917-423-5314
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Fax |
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Provider Business Mailing Address
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Address Line | 785 W END AVE APT 6C
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City | NEW YORK
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State | NY
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Zip | 10025-5451
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Country | US
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Telephone | 917-423-5336
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 001019
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License Number State | NY
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