1023099728 NPI number — MR. STEPHEN C FAY LCSW

Table of content: MR. STEPHEN C FAY LCSW (NPI 1023099728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023099728 NPI number — MR. STEPHEN C FAY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAY
Provider First Name:
STEPHEN
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023099728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 FRALEIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED HOOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12571-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-758-1107
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23H E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RHINEBECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12572-1639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-473-4675
Provider Business Practice Location Address Fax Number:
845-758-1107
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  PR026150-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7403800 . This is a "GHI PIN NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2775609 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 108640 . This is a "UBH PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 349572 . This is a "MVP PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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