Provider Demographics
NPI:1902233190
Name:MEWHINNEY, STEPHANIE RACHEL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RACHEL
Last Name:MEWHINNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:475 E MAIN ST
Mailing Address - Street 2:1ST FLOOR, SUITE 101
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3121
Mailing Address - Country:US
Mailing Address - Phone:631-363-2001
Mailing Address - Fax:631-687-5834
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:1ST FLOOR, SUITE 101
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-363-2001
Practice Address - Fax:631-687-5834
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086385-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical