Provider Demographics
NPI:1972735595
Name:STEVENS, PAUL E (LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:984 N BROADWAY
Mailing Address - Street 2:SUITE 419
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1318
Mailing Address - Country:US
Mailing Address - Phone:914-966-7068
Mailing Address - Fax:718-601-6253
Practice Address - Street 1:5700 ARLINGTON AVE
Practice Address - Street 2:APT. 9 G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1503
Practice Address - Country:US
Practice Address - Phone:718-601-8846
Practice Address - Fax:718-601-6253
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65250451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN61511Medicare UPIN