Provider Demographics
NPI:1992554836
Name:HERTEL, STEPHANIE S (LMSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:HERTEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4610
Mailing Address - Country:US
Mailing Address - Phone:607-206-6855
Mailing Address - Fax:
Practice Address - Street 1:54 NOLL ST APT 714
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5361
Practice Address - Country:US
Practice Address - Phone:607-206-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123353104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker