Provider Demographics
NPI:1740342500
Name:STEPHEN, IRNEL L (LCSW)
Entity type:Individual
Prefix:
First Name:IRNEL
Middle Name:L
Last Name:STEPHEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:IRNEL
Other - Middle Name:L
Other - Last Name:STEPHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:12904 HOOK CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1123
Mailing Address - Country:US
Mailing Address - Phone:718-525-8212
Mailing Address - Fax:
Practice Address - Street 1:333 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5803
Practice Address - Country:US
Practice Address - Phone:718-522-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR013798104100000X, 1041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool