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General NPI Number Information
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NPI Number | 1568996247
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Entity Type | Individual
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Provider Name | STEPHANIE GBAGUIDI BSW
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Gender | Female
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 10000 BEACH CHANNEL DR
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City | FAR ROCKAWAY
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State | NY
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Zip | 11694-2818
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Country | US
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Telephone | 718-734-3290
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Fax |
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Provider Business Mailing Address
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Address Line | 14620 232ND ST
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-4443
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Country | US
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Telephone | 201-344-1868
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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