Provider Demographics
NPI:1104675727
Name:MINEO, STEPHANIE A (MHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:MINEO
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CHELSEA RIDGE DR APT F
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5632
Mailing Address - Country:US
Mailing Address - Phone:845-764-1230
Mailing Address - Fax:
Practice Address - Street 1:633 GIDNEY AVE STE 6
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2805
Practice Address - Country:US
Practice Address - Phone:845-569-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP128010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health