Provider Demographics
NPI:1659371649
Name:STELLMAN, MICHAEL R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:STELLMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4 STANTON CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-1217
Mailing Address - Country:US
Mailing Address - Phone:914-632-4830
Mailing Address - Fax:914-633-5406
Practice Address - Street 1:29 BARSTOW RD
Practice Address - Street 2:STE 205
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2209
Practice Address - Country:US
Practice Address - Phone:914-632-4830
Practice Address - Fax:914-633-5406
Is Sole Proprietor?:No
Enumeration Date:2005-07-31
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0217901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0072956OtherGHI-BMP
NY0072956OtherGHI-BMP