Provider Demographics
NPI:1063684975
Name:STERN, VIRGINIA FRASER (LCSW-R)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:FRASER
Last Name:STERN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W 71ST ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4141
Mailing Address - Country:US
Mailing Address - Phone:917-992-5571
Mailing Address - Fax:
Practice Address - Street 1:17 W 71ST ST APT 3C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4141
Practice Address - Country:US
Practice Address - Phone:917-992-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0173371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical