Provider Demographics
NPI:1841233459
Name:POPLOCK, STEPHANIE HELENA (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:HELENA
Last Name:POPLOCK
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820
Mailing Address - Country:US
Mailing Address - Phone:607-433-2343
Mailing Address - Fax:607-433-6229
Practice Address - Street 1:242 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820
Practice Address - Country:US
Practice Address - Phone:607-433-2343
Practice Address - Fax:607-433-6229
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0779951041C0700X, 1041C0700X
NY018721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098304OtherANTHEM LEGACY NUMBER
NY03641807Medicaid
NYJ400040149OtherMEDICARE PTAN
ME421230099Medicaid