Provider Demographics
NPI:1578999280
Name:TRICIA STEPHENS LCSW-R PLLC
Entity type:Organization
Organization Name:TRICIA STEPHENS LCSW-R PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-504-6853
Mailing Address - Street 1:306 GOLD ST
Mailing Address - Street 2:29C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3014
Mailing Address - Country:US
Mailing Address - Phone:646-504-6853
Mailing Address - Fax:
Practice Address - Street 1:306 GOLD ST
Practice Address - Street 2:29C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3014
Practice Address - Country:US
Practice Address - Phone:646-504-6853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0749231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty