Provider Demographics
NPI:1679644918
Name:SODDEN, STEWART (LMHC)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:
Last Name:SODDEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 AVENUE O
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6615
Mailing Address - Country:US
Mailing Address - Phone:719-336-6073
Mailing Address - Fax:718-336-6072
Practice Address - Street 1:390 KINGS HWY # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1614
Practice Address - Country:US
Practice Address - Phone:718-336-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251300000X
NY005888251C00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health