Provider Demographics
NPI:1326473893
Name:SOCOLICK, STEPHANIE (ATR-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SOCOLICK
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6502
Mailing Address - Country:US
Mailing Address - Phone:917-841-2253
Mailing Address - Fax:
Practice Address - Street 1:75 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6502
Practice Address - Country:US
Practice Address - Phone:917-841-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health