Provider Demographics
NPI:1588376636
Name:XANTHOUDAKIS, STELLA (MSED, MA)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:XANTHOUDAKIS
Suffix:
Gender:F
Credentials:MSED, MA
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:
Other - Last Name:XANTHOUDAKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED, MA
Mailing Address - Street 1:20 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3436
Mailing Address - Country:US
Mailing Address - Phone:516-477-9247
Mailing Address - Fax:
Practice Address - Street 1:350 JERICHO TPKE STE 103
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1317
Practice Address - Country:US
Practice Address - Phone:516-477-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP111460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty