Provider Demographics
NPI:1124834445
Name:OSIKA, STEPHEN THOMAS (LPC-A)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:OSIKA
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 EAST AVE STE 2N
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5741
Mailing Address - Country:US
Mailing Address - Phone:203-793-6055
Mailing Address - Fax:
Practice Address - Street 1:128 EAST AVE STE 2N
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5741
Practice Address - Country:US
Practice Address - Phone:203-793-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health