Provider Demographics
NPI:1285000489
Name:STEINER, MICHELLE JESSICA (MS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:JESSICA
Last Name:STEINER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-2350
Mailing Address - Country:US
Mailing Address - Phone:347-472-4792
Mailing Address - Fax:347-225-8619
Practice Address - Street 1:725 LEONARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2350
Practice Address - Country:US
Practice Address - Phone:347-472-4792
Practice Address - Fax:347-225-8619
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102453120Medicaid