Provider Demographics
NPI:1093472573
Name:PELAIA, STEPHEN T (LMSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:T
Last Name:PELAIA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16121 JAMAICA AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6113
Mailing Address - Country:US
Mailing Address - Phone:718-896-2500
Mailing Address - Fax:718-459-6542
Practice Address - Street 1:475 ATLANTIC AVE STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4383
Practice Address - Country:US
Practice Address - Phone:718-717-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106542104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker