Provider Demographics
NPI:1376127340
Name:FORTIN, STEFANY (MSC LCSW)
Entity Type:Individual
Prefix:
First Name:STEFANY
Middle Name:
Last Name:FORTIN
Suffix:
Gender:F
Credentials:MSC LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 20TH ST STE 804
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9254
Mailing Address - Country:US
Mailing Address - Phone:929-256-0720
Mailing Address - Fax:
Practice Address - Street 1:20 W 20TH ST STE 804
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9254
Practice Address - Country:US
Practice Address - Phone:929-256-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109794-01104100000X
NY0965021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker