Provider Demographics
NPI:1770505315
Name:STILLSON, KATHY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:STILLSON
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 1:262 FURNACE DOCK RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-788-3713
Mailing Address - Fax:914-788-0904
Practice Address - Street 1:97 45 QUEENS BLVD
Practice Address - Street 2:8TH FLOOR CO HIP MENTAL HEALTH
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-459-0500
Practice Address - Fax:718-997-6817
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0218001041C0700X
CT0038191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical