Provider Demographics
NPI:1063964054
Name:NGELEZI, STEPHANIE JEANETTE MANNION
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEANETTE MANNION
Last Name:NGELEZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:MANNION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6928
Mailing Address - Country:US
Mailing Address - Phone:845-616-6008
Mailing Address - Fax:
Practice Address - Street 1:3 LEAR JET LN STE 104N
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2314
Practice Address - Country:US
Practice Address - Phone:518-560-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097658-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker