MEDICARE: DR. GABRIELLE STUTMAN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	007131	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	WCS071316B	OTHER	NY	WORKERS COMP

General Provider Information

NPI Number	:	1144213463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIELLE STUTMAN PHD

Provider Business Mailing Address
First Line	:	116 ROUND HILL RD
Second Line	:
City	:	DOBBS FERRY
State	:	NY
Zip	:	10522-3305
Country	:	US
Telephone Number	:	914-693-5045
Fax Number	:	914-693-5044

Provider Business Practice Location Address
First Line	:	303 5TH AVE
Second Line	:	SUITE 907
City	:	NEW YORK
State	:	NY
Zip	:	10016-6601
Country	:	US
Telephone Number	:	212-254-7390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	10/02/2012

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