Provider Demographics
NPI:1851570980
Name:FODOR, STEFAN HORIA (LMHC)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:HORIA
Last Name:FODOR
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4146
Mailing Address - Country:US
Mailing Address - Phone:516-705-4732
Mailing Address - Fax:
Practice Address - Street 1:7559 263RD ST
Practice Address - Street 2:ACP
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1150
Practice Address - Country:US
Practice Address - Phone:718-470-8322
Practice Address - Fax:718-347-5514
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health