Provider Demographics
NPI:1124037999
Name:STIENE, RACHEL SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SUSAN
Last Name:STIENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 QUEENS BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5511
Mailing Address - Country:US
Mailing Address - Phone:718-896-3400
Mailing Address - Fax:
Practice Address - Street 1:10504 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5022
Practice Address - Country:US
Practice Address - Phone:718-681-8700
Practice Address - Fax:718-943-6788
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0544521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420795Medicaid
NYN532Z32321Medicare PIN