Provider Demographics
NPI:1043374697
Name:STEVENS, BRIAN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:STEVENS
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 1:309 E 5TH ST
Mailing Address - Street 2:APT 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-8825
Mailing Address - Country:US
Mailing Address - Phone:212-260-8566
Mailing Address - Fax:
Practice Address - Street 1:420 W 24TH ST
Practice Address - Street 2:STE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1325
Practice Address - Country:US
Practice Address - Phone:212-260-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVN3561Medicare PIN