Provider Demographics
NPI:1376089243
Name:STERN, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:GODNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1047 OLD NORTHERN BLVD
Mailing Address - Street 2:C/O- CSI-NY
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1627
Mailing Address - Country:US
Mailing Address - Phone:516-621-1281
Mailing Address - Fax:516-621-1259
Practice Address - Street 1:1047 OLD NORTHERN BLVD
Practice Address - Street 2:C/O- CSI-NY
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1627
Practice Address - Country:US
Practice Address - Phone:516-621-1281
Practice Address - Fax:516-621-1259
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator