Provider Demographics
NPI:1013193358
Name:MAISTO, STEPHEN ALBERT (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALBERT
Last Name:MAISTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT OF PSYCHOLOGY SYRACUSE UNIVERSITY
Mailing Address - Street 2:430 HUNTINGTON HALL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13244-0001
Mailing Address - Country:US
Mailing Address - Phone:315-443-2334
Mailing Address - Fax:315-443-4085
Practice Address - Street 1:800 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2716
Practice Address - Country:US
Practice Address - Phone:315-425-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist