Provider Demographics
NPI:1235769019
Name:STEPHANIE N. STRAUB, LCSW, PLLC
Entity Type:Organization
Organization Name:STEPHANIE N. STRAUB, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-552-0180
Mailing Address - Street 1:5111 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2357
Mailing Address - Country:US
Mailing Address - Phone:315-552-0180
Mailing Address - Fax:
Practice Address - Street 1:5111 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2357
Practice Address - Country:US
Practice Address - Phone:315-552-0180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health