Provider Demographics
NPI:1598463085
Name:JEANTY, STEPHANIE (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JEANTY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 HENDRIX ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-9104
Mailing Address - Country:US
Mailing Address - Phone:347-210-4173
Mailing Address - Fax:
Practice Address - Street 1:1028 HENDRIX ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-9104
Practice Address - Country:US
Practice Address - Phone:347-210-4173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098087104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker