Provider Demographics
NPI:1063787489
Name:DITCHIK-STUTZ, JOANNE (LCSW)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:DITCHIK-STUTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HILLDALE DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1021
Mailing Address - Country:US
Mailing Address - Phone:516-305-8632
Mailing Address - Fax:
Practice Address - Street 1:7 HILLDALE DR
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1021
Practice Address - Country:US
Practice Address - Phone:516-305-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0207131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical