Provider Demographics
NPI:1376615872
Name:STUKALIN, JOEL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:J
Last Name:STUKALIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 WEST 12TH STREET
Mailing Address - Street 2:SUITE 6K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8112
Mailing Address - Country:US
Mailing Address - Phone:718-544-6400
Mailing Address - Fax:718-544-6400
Practice Address - Street 1:101 WEST 12TH STREET
Practice Address - Street 2:SUITE 6K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8112
Practice Address - Country:US
Practice Address - Phone:718-544-6400
Practice Address - Fax:718-544-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical