MEDICARE: MR. GEOFFREY B STAHL MENTAL HEALTH COUNSE

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	101YM0800X	Mental Health Counselor	000833	NY

General Provider Information

NPI Number	:	1790850782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEOFFREY B STAHL MENTAL HEALTH COUNSE

Provider Business Mailing Address
First Line	:	47-4 48 AVE
Second Line	:	3S
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109
Country	:	US
Telephone Number	:	718-986-5622
Fax Number	:	212-423-6326

Provider Business Practice Location Address
First Line	:	47-4 48 AVENUE
Second Line	:	3S
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109
Country	:	US
Telephone Number	:	718-986-5622
Fax Number	:	212-423-6326

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	07/08/2007

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