Provider Demographics
NPI:1073769253
Name:PEARL, STEPHANIE ERIN
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ERIN
Last Name:PEARL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E 80TH ST
Mailing Address - Street 2:1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0117
Mailing Address - Country:US
Mailing Address - Phone:978-697-7810
Mailing Address - Fax:
Practice Address - Street 1:19 E 80TH ST
Practice Address - Street 2:1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0117
Practice Address - Country:US
Practice Address - Phone:978-697-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245029Medicaid