Provider Demographics
NPI:1659247203
Name:STEVENS, SHIRLEY ANN (LMSW)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:STEVENS
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 1:3635 BELL BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2097
Mailing Address - Country:US
Mailing Address - Phone:718-504-9256
Mailing Address - Fax:
Practice Address - Street 1:11154 COUNTRYMAN RD
Practice Address - Street 2:
Practice Address - City:REMSEN
Practice Address - State:NY
Practice Address - Zip Code:13438-4223
Practice Address - Country:US
Practice Address - Phone:315-240-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127940104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty