Provider Demographics
NPI:1447347414
Name:CRAIG, STEPHANIE ELIZABETH (LCSW-R)
Entity type:Individual
Prefix:PROF
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 WILLIAMSON TER
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1229
Mailing Address - Country:US
Mailing Address - Phone:607-776-3616
Mailing Address - Fax:
Practice Address - Street 1:133 WILLIAMSON TER
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1229
Practice Address - Country:US
Practice Address - Phone:607-776-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-045003-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical