Provider Demographics
NPI:1578776126
Name:STERN, JASON D (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:D
Last Name:STERN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 COLIN DR
Mailing Address - Street 2:
Mailing Address - City:EAST YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1521
Mailing Address - Country:US
Mailing Address - Phone:631-205-5820
Mailing Address - Fax:
Practice Address - Street 1:141 COLIN DR
Practice Address - Street 2:
Practice Address - City:EAST YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11967-1521
Practice Address - Country:US
Practice Address - Phone:631-205-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074249-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker