1063811925 NPI number — STEPHANIE DELL'AQUILA STEVENS, LCSW

Table of content: (NPI 1063811925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063811925 NPI number — STEPHANIE DELL'AQUILA STEVENS, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHANIE DELL'AQUILA STEVENS, LCSW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1063811925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARANAC LAKE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12983-1191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-637-5134
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 WOODRUFF ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-637-5134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENS
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
DELL'AQUILA
Authorized Official Title or Position:
THERAPIST, PRIVATE PRACTITIONER
Authorized Official Telephone Number:
518-637-5134

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  076898-1 , 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)





Copyright © 2007-2025 www.npivalidator.com