Provider Demographics
NPI:1528541646
Name:STELLA, EDINA
Entity Type:Individual
Prefix:
First Name:EDINA
Middle Name:
Last Name:STELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:STELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2329 ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5407
Mailing Address - Country:US
Mailing Address - Phone:570-815-9423
Mailing Address - Fax:
Practice Address - Street 1:2329 ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5407
Practice Address - Country:US
Practice Address - Phone:570-815-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103129-11041C0700X, 253J00000X
NY03129-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No253J00000XAgenciesFoster Care Agency