Provider Demographics
NPI:1285819805
Name:STEPAKOFF, SHANEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHANEE
Middle Name:
Last Name:STEPAKOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:STEPAKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:110 ELM ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6807
Mailing Address - Country:US
Mailing Address - Phone:646-596-6792
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:SUITE 1405
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:646-596-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017212103TC2200X, 103TC0700X, 103TP2701X, 102X00000X, 103TF0000X
MA7651103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300066781OtherMEDICARE PTAN
PENDINGMedicare UPIN
PENDINGMedicare PIN