Provider Demographics
NPI:1326125378
Name:STEVENSON, FELICIA MONIQUE (BSW, CASAC-T)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:MONIQUE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:BSW, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-2209
Mailing Address - Country:US
Mailing Address - Phone:716-848-2076
Mailing Address - Fax:716-848-2249
Practice Address - Street 1:425 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2209
Practice Address - Country:US
Practice Address - Phone:716-848-2076
Practice Address - Fax:716-848-2249
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)