=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538228085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN MCDONNELL LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 01/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 7TH AVE STE 710
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-304-1060
-----------------------------------------------------
Fax | 347-382-9422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 421 7TH AVE STE 710
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-304-1060
-----------------------------------------------------
Fax | 347-382-9422
-----------------------------------------------------
=====================================================
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 | 077256
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------