Provider Demographics
NPI:1861673634
Name:STILLMAN, CELINE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:CELINE
Middle Name:
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 ROUTE 9W S
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-5020
Mailing Address - Country:US
Mailing Address - Phone:917-519-9657
Mailing Address - Fax:845-365-6330
Practice Address - Street 1:779 ROUTE 9W S
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-5020
Practice Address - Country:US
Practice Address - Phone:917-519-9657
Practice Address - Fax:845-365-6330
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073534-11041C0700X
NYR076599-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00073534Medicaid