Provider Demographics
NPI:1063811925
Name:STEPHANIE DELL'AQUILA STEVENS, LCSW
Entity type:Organization
Organization Name:STEPHANIE DELL'AQUILA STEVENS, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, PRIVATE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DELL'AQUILA
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-637-5134
Mailing Address - Street 1:212 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1191
Mailing Address - Country:US
Mailing Address - Phone:518-637-5134
Mailing Address - Fax:
Practice Address - Street 1:88 WOODRUFF ST
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1713
Practice Address - Country:US
Practice Address - Phone:518-637-5134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-17
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076898-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health