Provider Demographics
NPI:1194010132
Name:DEORIO, STEPHEN JAMES (PH D LCSW)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:DEORIO
Suffix:
Gender:M
Credentials:PH D LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LINCOLN AVE APT 4M
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2821
Mailing Address - Country:US
Mailing Address - Phone:516-662-6053
Mailing Address - Fax:
Practice Address - Street 1:101 LINCOLN AVE APT 4M
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2821
Practice Address - Country:US
Practice Address - Phone:516-662-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0398721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical