Provider Demographics
NPI:1629358791
Name:WEST, STEPHANIE AOIFE (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:AOIFE
Last Name:WEST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:S.
Other - Middle Name:AOIFE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:415 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1EL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4856
Mailing Address - Country:US
Mailing Address - Phone:917-658-8290
Mailing Address - Fax:
Practice Address - Street 1:415 CENTRAL PARK W
Practice Address - Street 2:SUITE 1EL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4856
Practice Address - Country:US
Practice Address - Phone:917-658-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019168103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent