Provider Demographics
NPI:1922298769
Name:STERN, IZETTA SIEGAL (LCSW,BCD)
Entity Type:Individual
Prefix:MS
First Name:IZETTA
Middle Name:SIEGAL
Last Name:STERN
Suffix:
Gender:F
Credentials:LCSW,BCD
Other - Prefix:MS
Other - First Name:IZETTA
Other - Middle Name:S
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW,BCD
Mailing Address - Street 1:85 5TH AVE
Mailing Address - Street 2:ROOM 906
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3019
Mailing Address - Country:US
Mailing Address - Phone:212-691-1266
Mailing Address - Fax:
Practice Address - Street 1:85 5TH AVE
Practice Address - Street 2:ROOM 906
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3019
Practice Address - Country:US
Practice Address - Phone:212-691-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013040-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical