Provider Demographics
NPI:1790850782
Name:STAHL, GEOFFREY B (MENTAL HEALTH COUNSE)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:B
Last Name:STAHL
Suffix:
Gender:M
Credentials:MENTAL HEALTH COUNSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-4 48 AVE
Mailing Address - Street 2:3S
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109
Mailing Address - Country:US
Mailing Address - Phone:718-986-5622
Mailing Address - Fax:212-423-6326
Practice Address - Street 1:47-4 48 AVENUE
Practice Address - Street 2:3S
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109
Practice Address - Country:US
Practice Address - Phone:718-986-5622
Practice Address - Fax:212-423-6326
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health