Provider Demographics
NPI:1518088046
Name:CROVELLO, STEPHEN J (LCSW PC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:J
Last Name:CROVELLO
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Gender:M
Credentials:LCSW PC
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Mailing Address - Street 1:1050 HALLOCK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1214
Mailing Address - Country:US
Mailing Address - Phone:631-474-4777
Mailing Address - Fax:631-476-0766
Practice Address - Street 1:1050 HALLOCK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1214
Practice Address - Country:US
Practice Address - Phone:631-474-4777
Practice Address - Fax:631-476-0766
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR040971-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical