Provider Demographics
NPI:1326394560
Name:CHAVARRIAGA, STEPHANIE
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:CHAVARRIAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 95TH ST
Mailing Address - Street 2:APT. C10
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-8510
Mailing Address - Country:US
Mailing Address - Phone:347-870-8164
Mailing Address - Fax:
Practice Address - Street 1:535 8TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4305
Practice Address - Country:US
Practice Address - Phone:212-787-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2015-09-22
Deactivation Date:2012-08-14
Deactivation Code:
Reactivation Date:2015-09-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator