Provider Demographics
NPI:1194418087
Name:GUTKIN, STEPHANIE LUCIA (MSED)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LUCIA
Last Name:GUTKIN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RIVERSIDE BLVD APT 5H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0507
Mailing Address - Country:US
Mailing Address - Phone:203-258-5295
Mailing Address - Fax:
Practice Address - Street 1:120 RIVERSIDE BLVD APT 5H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069-0507
Practice Address - Country:US
Practice Address - Phone:203-258-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool