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General NPI Number Information
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NPI Number | 1770505315
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Entity Type | Individual
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Provider Name | KATHY STILLSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 97 45 QUEENS BLVD 8TH FLOOR CO HIP MENTAL HEALTH
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 718-459-0500
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Fax | 718-997-6817
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Provider Business Mailing Address
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Address Line | 262 FURNACE DOCK RD
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567
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Country | US
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Telephone | 914-788-3713
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Fax | 914-788-0904
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PR021800
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 003819
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License Number State | CT
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