Provider Demographics
NPI:1407298078
Name:TAYLOR, STEPHEN S (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 WANTAGH AVE
Mailing Address - Street 2:SOUTH SHORE COUNSELING
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2109
Mailing Address - Country:US
Mailing Address - Phone:516-785-0323
Mailing Address - Fax:516-785-6026
Practice Address - Street 1:1051 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2109
Practice Address - Country:US
Practice Address - Phone:516-785-0323
Practice Address - Fax:516-785-6026
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7204098103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist