Provider Demographics
NPI:1558846212
Name:FUERTES, STEPHANIE GISELLE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GISELLE
Last Name:FUERTES
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 1:115 MAPLE ST APT 2L
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-5782
Mailing Address - Country:US
Mailing Address - Phone:570-620-8747
Mailing Address - Fax:
Practice Address - Street 1:260 BROADWAY FL 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8433
Practice Address - Country:US
Practice Address - Phone:347-505-5155
Practice Address - Fax:718-388-0896
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health