Provider Demographics
NPI:1598887978
Name:STEPHENS, MAURICE L (CASAC)
Entity type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:L
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11918 202ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3816
Mailing Address - Country:US
Mailing Address - Phone:718-525-2610
Mailing Address - Fax:
Practice Address - Street 1:91-01 MERRICK BLVD.
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-523-4242
Practice Address - Fax:718-206-4849
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11106101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)