Provider Demographics
NPI:1962543025
Name:STIEL, ROBERTA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:STIEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3745
Mailing Address - Country:US
Mailing Address - Phone:203-324-7222
Mailing Address - Fax:203-324-7222
Practice Address - Street 1:500 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3745
Practice Address - Country:US
Practice Address - Phone:203-324-7222
Practice Address - Fax:203-324-7222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4105517Medicaid
CT4105517Medicaid