Provider Demographics
NPI:1659894095
Name:TRUESDELL, STEPHANIE BROOKE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:BROOKE
Last Name:TRUESDELL
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 1:107 BEARKILL RD
Mailing Address - Street 2:
Mailing Address - City:GILBOA
Mailing Address - State:NY
Mailing Address - Zip Code:12076-3601
Mailing Address - Country:US
Mailing Address - Phone:518-810-5324
Mailing Address - Fax:
Practice Address - Street 1:905 GREENE COUNTY OFFICE BLDG
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-2868
Practice Address - Country:US
Practice Address - Phone:518-622-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100947104100000X
NY096506-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker