Provider Demographics
NPI:1407403009
Name:STEJBACH, GAELEN (LCSW)
Entity Type:Individual
Prefix:
First Name:GAELEN
Middle Name:
Last Name:STEJBACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARK AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-9331
Mailing Address - Country:US
Mailing Address - Phone:212-988-6376
Mailing Address - Fax:
Practice Address - Street 1:505 PARK AVE STE 400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-9331
Practice Address - Country:US
Practice Address - Phone:122-988-6376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106957104100000X
NY0948301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker