MEDICARE: CRYSTAL STEPHENS

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1336955939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL STEPHENS

Provider Business Mailing Address
First Line	:	14611 231ST ST
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11413-4427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14611 231ST ST
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11413-4427
Country	:	US
Telephone Number	:	347-843-9424
Fax Number	:

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

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	12/09/2024

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Directions to “ CRYSTAL STEPHENS ” Practice Location

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