Provider Demographics
NPI:1114434685
Name:ASTUDILLO, STEPHANIE ROCIO
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROCIO
Last Name:ASTUDILLO
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 1:5254 79TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4101
Mailing Address - Country:US
Mailing Address - Phone:347-261-6065
Mailing Address - Fax:
Practice Address - Street 1:41 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1160
Practice Address - Country:US
Practice Address - Phone:646-762-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health