Provider Demographics
NPI:1760252787
Name:STUART-TOUSSAINT, SAFIYA NADIRA
Entity Type:Individual
Prefix:
First Name:SAFIYA
Middle Name:NADIRA
Last Name:STUART-TOUSSAINT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15722 POWELLS COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEECHHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1332
Mailing Address - Country:US
Mailing Address - Phone:347-280-3591
Mailing Address - Fax:
Practice Address - Street 1:333 REMSEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1245
Practice Address - Country:US
Practice Address - Phone:917-543-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1360987106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty