MEDICARE: STEPHANIE BONESTEEL

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	305R00000X	Preferred Provider Organization	081220-1	NY

General Provider Information

NPI Number	:	1730517434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE BONESTEEL

Provider Business Mailing Address
First Line	:	53 W 8TH ST
Second Line	:	APT. 4FE
City	:	NEW YORK
State	:	NY
Zip	:	10011-9022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 W 8TH ST
Second Line	:	APT. 4FE
City	:	NEW YORK
State	:	NY
Zip	:	10011-9022
Country	:	US
Telephone Number	:	646-279-8795
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	STEPHANIE BONESTEEL
Credential	:	LCSW
Telephone Number	:	646-279-8795

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	10/16/2013

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