Provider Demographics
NPI:1689111205
Name:RONDA, STEPHEN (LMHC, CASAC-M)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:RONDA
Suffix:
Gender:M
Credentials:LMHC, CASAC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3311
Mailing Address - Country:US
Mailing Address - Phone:845-320-3600
Mailing Address - Fax:
Practice Address - Street 1:19 N RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3311
Practice Address - Country:US
Practice Address - Phone:845-320-3600
Practice Address - Fax:845-320-3700
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34944101YA0400X
NJ37PC00957800101YP2500X
NY007590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional