Provider Demographics
NPI:1437556610
Name:STOVALL, NATASHA (PHD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:STOVALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 BAY RIDGE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5804
Mailing Address - Country:US
Mailing Address - Phone:718-344-1734
Mailing Address - Fax:
Practice Address - Street 1:1140 BROADWAY RM 204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7504
Practice Address - Country:US
Practice Address - Phone:718-344-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0222381103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical