Provider Demographics
NPI:1164998902
Name:STECKLER, NANCY MIRIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MIRIAM
Last Name:STECKLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AMUNDSEN LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1705
Mailing Address - Country:US
Mailing Address - Phone:914-450-9985
Mailing Address - Fax:
Practice Address - Street 1:450 WEST NYACK ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1756
Practice Address - Country:US
Practice Address - Phone:845-354-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020550103TC0700X
NY020550-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020550-1OtherNY STATE PSYCHOLOGIST LICENSE NUMBER