Provider Demographics
NPI:1700200094
Name:WAYNE, STEPHANIE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:WAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13534 82ND DR
Mailing Address - Street 2:APT 3A
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1469
Mailing Address - Country:US
Mailing Address - Phone:914-319-0959
Mailing Address - Fax:
Practice Address - Street 1:13534 82ND DR
Practice Address - Street 2:APT 3A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1469
Practice Address - Country:US
Practice Address - Phone:914-319-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081492-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical