Provider Demographics
NPI:1033273016
Name:MONAGHAN-BAXTER, STEPHANIE SARAH (MSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SARAH
Last Name:MONAGHAN-BAXTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SARAH
Other - Last Name:MONAGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:6594 COUNTY ROUTE 24
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:NY
Mailing Address - Zip Code:13625-3113
Mailing Address - Country:US
Mailing Address - Phone:315-265-0222
Mailing Address - Fax:
Practice Address - Street 1:23 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1017
Practice Address - Country:US
Practice Address - Phone:315-769-8441
Practice Address - Fax:315-769-8441
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075281-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker