MEDICARE: SHAWNTAE STEVENSON LCSW

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	104100000X	Social Worker	095374-1	NY
2	104100000X	Social Worker	LCSW-23328	AZ

General Provider Information

NPI Number	:	1659736098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNTAE STEVENSON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 860912
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55486-0912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PLACE
Second Line	:	MOUNT SINAI HOSPITAL
City	:	NEW YORK
State	:	NY
Zip	:	10029-6574
Country	:	US
Telephone Number	:	206-841-2665
Fax Number	:

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

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	05/15/2026

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