Provider Demographics
NPI:1477599520
Name:NOLAND, STEPHANIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:NOLAND
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 1:203 W 90TH ST
Mailing Address - Street 2:#6H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1219
Mailing Address - Country:US
Mailing Address - Phone:212-580-3994
Mailing Address - Fax:212-580-3951
Practice Address - Street 1:344 W 72ND ST
Practice Address - Street 2:SUITE ONE-I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2625
Practice Address - Country:US
Practice Address - Phone:212-580-3994
Practice Address - Fax:212-580-3951
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005082-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV4C491Medicare ID - Type Unspecified