Provider Demographics
NPI:1558772566
Name:MILLSTEIN, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MILLSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W 34TH ST
Mailing Address - Street 2:#5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2303
Mailing Address - Country:US
Mailing Address - Phone:917-514-1897
Mailing Address - Fax:
Practice Address - Street 1:440 W 34TH ST
Practice Address - Street 2:#5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2303
Practice Address - Country:US
Practice Address - Phone:917-514-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR023166-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR023166-1OtherLICENSED CLINICAL SOCIAL WORKER