Provider Demographics
NPI:1992144349
Name:SANTACROCE, STEPHANIE (MS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SANTACROCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MARTINS RD
Mailing Address - Street 2:
Mailing Address - City:HUGUENOT
Mailing Address - State:NY
Mailing Address - Zip Code:12746-5041
Mailing Address - Country:US
Mailing Address - Phone:607-222-9562
Mailing Address - Fax:
Practice Address - Street 1:1997 ROUTE 17M STE 9
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5233
Practice Address - Country:US
Practice Address - Phone:845-294-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024340-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist