Provider Demographics
NPI:1447302955
Name:HALPERN, STACEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:HALPERN
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 1:10230 QUEENS BL
Mailing Address - Street 2:#LC
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-459-0109
Mailing Address - Fax:718-459-0109
Practice Address - Street 1:10230 QUEENS BL
Practice Address - Street 2:#LC
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-459-0109
Practice Address - Fax:718-459-0109
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0105711103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical