Provider Demographics
NPI:1598202780
Name:STADLER, STEFANIE (LCSW)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:STADLER
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 1:80 MAPLE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3520
Mailing Address - Country:US
Mailing Address - Phone:631-682-7451
Mailing Address - Fax:501-745-2378
Practice Address - Street 1:80 MAPLE AVE STE 201
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3520
Practice Address - Country:US
Practice Address - Phone:631-682-7451
Practice Address - Fax:501-745-2378
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088437104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker