Provider Demographics
NPI:1508977950
Name:CARLSON, STEPHANIE (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5676 RIVERDALE AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2138
Mailing Address - Country:US
Mailing Address - Phone:718-796-5300
Mailing Address - Fax:
Practice Address - Street 1:5676 RIVERDALE AVE
Practice Address - Street 2:STE. 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2138
Practice Address - Country:US
Practice Address - Phone:718-796-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010343-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical