Provider Demographics
NPI:1720190887
Name:BELL, STEPHEN PARKS (LMSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PARKS
Last Name:BELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:DEADELUS
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144-15 78TH ROAD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-591-0177
Mailing Address - Fax:718-845-9380
Practice Address - Street 1:14415 78TH RD APT 2B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3563
Practice Address - Country:US
Practice Address - Phone:718-591-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00069712104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00069712Medicaid