Provider Demographics
NPI:1336699826
Name:QUITO, STEPHANIE JOANN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JOANN
Last Name:QUITO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 CENTRAL AVE
Mailing Address - Street 2:2ND FL.
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4002
Mailing Address - Country:US
Mailing Address - Phone:718-868-1100
Mailing Address - Fax:
Practice Address - Street 1:1624 CENTRAL AVE
Practice Address - Street 2:2ND FL.
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4002
Practice Address - Country:US
Practice Address - Phone:718-868-1100
Practice Address - Fax:718-732-2973
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098151104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker