Provider Demographics
NPI:1255507893
Name:STERN, FREDERICK PRESTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:PRESTON
Last Name:STERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W 77TH ST
Mailing Address - Street 2:12B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5116
Mailing Address - Country:US
Mailing Address - Phone:212-874-4530
Mailing Address - Fax:
Practice Address - Street 1:50 W 77TH ST
Practice Address - Street 2:12B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5116
Practice Address - Country:US
Practice Address - Phone:212-874-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008673-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical