Provider Demographics
NPI:1043604523
Name:REBECCA STAMAT
Entity Type:Organization
Organization Name:REBECCA STAMAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-558-0786
Mailing Address - Street 1:16 CORNERSTONE CT STE 5
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1551
Mailing Address - Country:US
Mailing Address - Phone:203-558-0786
Mailing Address - Fax:
Practice Address - Street 1:16 CORNERSTONE CT STE 5
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1551
Practice Address - Country:US
Practice Address - Phone:203-558-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD300060350OtherPTAN