Provider Demographics
NPI:1518452226
Name:STEPHENSON, CRAIG EVAN
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:EVAN
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 W END AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5451
Mailing Address - Country:US
Mailing Address - Phone:917-423-5336
Mailing Address - Fax:
Practice Address - Street 1:25 CENTRAL PARK W APT 1N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7210
Practice Address - Country:US
Practice Address - Phone:917-423-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001019102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst