Provider Demographics
NPI:1467597260
Name:ANDREOPOULOS, STEPHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:ANDREOPOULOS
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 1:143 WILLIS AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2610
Mailing Address - Country:US
Mailing Address - Phone:516-739-0234
Mailing Address - Fax:516-739-0234
Practice Address - Street 1:143 WILLIS AVE
Practice Address - Street 2:STE 1
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2610
Practice Address - Country:US
Practice Address - Phone:516-829-0855
Practice Address - Fax:516-829-0855
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015522103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02607936Medicaid
NYVN1541Medicare ID - Type Unspecified