Provider Demographics
NPI:1568996247
Name:GBAGUIDI, STEPHANIE (BSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GBAGUIDI
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14620 232ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-4443
Mailing Address - Country:US
Mailing Address - Phone:201-344-1868
Mailing Address - Fax:
Practice Address - Street 1:10000 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11694-2818
Practice Address - Country:US
Practice Address - Phone:718-734-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health