Provider Demographics
NPI:1154654598
Name:STERN-BAVUSO, DONNA RUTH (LCSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:RUTH
Last Name:STERN-BAVUSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 W 70TH ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4319
Mailing Address - Country:US
Mailing Address - Phone:917-940-8973
Mailing Address - Fax:212-792-6058
Practice Address - Street 1:125 WEST 72ND ST
Practice Address - Street 2:6F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4319
Practice Address - Country:US
Practice Address - Phone:917-940-8973
Practice Address - Fax:212-792-6058
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY081291-1OtherLCSW
NY1154654598OtherNPI