Provider Demographics
NPI:1447940044
Name:PANUTHOS, STEPHANIE (CRPA, CASAC-T)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PANUTHOS
Suffix:
Gender:F
Credentials:CRPA, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ROUTE 59 STE 111
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-369-9701
Mailing Address - Fax:
Practice Address - Street 1:100 ROUTE 59 STE 111
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10901-4927
Practice Address - Country:US
Practice Address - Phone:845-369-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 1041S0200X
NY3380175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool