Provider Demographics
NPI:1205360674
Name:MOREHOUSE, STEPHANIE (MHC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MOREHOUSE
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2130
Mailing Address - Country:US
Mailing Address - Phone:607-753-0234
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2111
Practice Address - Country:US
Practice Address - Phone:315-280-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336163963Medicaid