Provider Demographics
NPI:1568546745
Name:SECOLSKY, STEPHANIE (PH D)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:SECOLSKY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 18TH ST
Mailing Address - Street 2:#12R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2444
Mailing Address - Country:US
Mailing Address - Phone:212-673-8347
Mailing Address - Fax:212-673-8347
Practice Address - Street 1:150 E 18TH ST
Practice Address - Street 2:#12R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2444
Practice Address - Country:US
Practice Address - Phone:212-673-8347
Practice Address - Fax:212-673-8347
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006434-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV13801Medicare ID - Type Unspecified