Provider Demographics
NPI:1104995018
Name:STEPHENS, THOMAS CHRISTOPHER (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 DELAWARE AVENUE
Mailing Address - Street 2:DELAWARE EXECUTIVE OFFICE SUITES, SUITE 11
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-378-7210
Mailing Address - Fax:
Practice Address - Street 1:237 DELAWARE AVENUE
Practice Address - Street 2:DELAWARE EXECUTIVE OFFICE SUITES, SUITE 11
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-378-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0415881104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01906532Medicaid
NY12150BMedicare ID - Type Unspecified
523312Medicare UPIN