Provider Demographics
NPI:1003837477
Name:LIA, STEPHANIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:LIA
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 1:32 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-3502
Mailing Address - Country:US
Mailing Address - Phone:914-837-2685
Mailing Address - Fax:
Practice Address - Street 1:2039 PALMER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2483
Practice Address - Country:US
Practice Address - Phone:914-837-2685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016546-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist